Carcinoma of the Posterior Tongue Treated with Radiation

It is customary to group primary lingual carcinomas according to their site of origin. The most frequent locations are the lateral border, the base, and the anterior tip of the tongue, in that order (1). Most authors define that portion of the tongue limited anteriorly by the circum vallate papillae and posteriorly by the valleculae as the “base” (2). Tumors growing in this region are, at times, included in discussions of oropharyngeal and hypopharyngeal tumors, which occur in close anatomical proximity. Since the embryological formation of the posterior tongue enjoys a different origin from the anterior two-thirds, the two regions may have different tissue characteristics, and tumors arising in the base have been said to be more anaplastic (3). In this study, tumors of the extreme posterolateral tongue are considered with lesions of the true base, as defined above, in order to evaluate problems common to both regions. Outstanding among these problems are the difficulties in early diagnosis and the obstacles in the pathway of an adequate therapeutic approach. A persistent, although non-tender, mass in the free portion of the tongue can usually be detected early by the patient, and this often is the chief complaint leading him to his doctor. A similar process on the posterior tongue may remain out of sight, undetected and undisturbed for an unknown period of weeks or months, and may extend to adjacent areas and release emissary cells to lymph nodes in one or both sides of the neck before discovery. Local ulceration complicated by infection and pain characteristically direct attention to the fact that something is wrong. A sore throat, with attendant difficulty in swallowing, and a “kernel” in the neck are common findings in general practice and are often treated symptomatically, on the assumption that they are due to a simple infection, until persistence dictates more complete examination. A frequent symptomatic pattern associated with posterolateral tongue lesions is pain in the posterior jaw with radiation into the ear, face, and temple on the side of involvement. One cannot place too much stress on the importance of indirect mirror examinations and direct finger palpation of the posterior tongue in the presence of these complaints. The relative inaccessibility of the region accounts for the lack of a standard approach in therapy. External irradiation is among the most frequent methods employed (4, 5), but it may be poorly directed even when large treatment fields are used if the therapist conducts only a hurried preliminary examination. The difficulties inherent in directing intraoral cone therapy with accuracy are evident. Complete surgical extirpation of the lesions requires a highly skilled and courageous surgeon. When excision includes a portion of the pharynx and mandible, or when tracheotomy and laryngectomy are necessary to avoid dangers of aspiration, the functional and cosmetic results often leave much to be desired.