CPT® Code 41155

Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection (Commando type)

A glossectomy is a surgical procedure that involves the removal of part or all of the tongue. In the context of CPT® Code 41155, this procedure is performed as a composite operation that includes not only the glossectomy but also the resection of the floor of the mouth, a mandibular resection, and a radical neck dissection, commonly referred to as a Commando procedure. This complex surgical intervention is primarily indicated for the treatment of cancers affecting the tongue and oropharynx, particularly when there is involvement of the mandible. The procedure begins with the resection of the mandible, which is accessed through a visor flap technique. This technique entails making an incision along the lower gingival buccal sulcus, allowing for the elevation of the skin over the chin and lower lip to access the mandible. Following the mandible's resection, the mucosa of the floor of the mouth is incised to remove diseased tissue along with a margin of healthy tissue, which typically includes the soft tissue beneath the sublingual glands and may involve transection of the Wharton duct. The procedure also necessitates the removal of the affected portion of the tongue, again with a margin of healthy tissue. The resulting defects from this extensive resection are often repaired through additional reconstructive surgeries, which may involve skin grafts, free flap grafts, or mandibular reconstruction. It is important to note that CPT® Code 41155 is specifically utilized when the composite procedure is performed in conjunction with a radical neck dissection, which entails the excision of lymph node groups levels I-V, along with the removal of surrounding tissues, including the sternocleidomastoid muscle, internal jugular vein, and submandibular gland on the affected side, as well as potentially the anterior belly of the digastric muscle and the sternohyoid and sternothyroid muscles.