Bloodgood* has recently written a short, but stimulating, article on treatment of cancer of the tongue. He states that in" the very early cases-that is, where malignant change is just taking place- a complete local removal with the cautery will nearly always effect a cure. Referring to the later cases, Bloodgood states:
"It has been demonstrated that.the failure to cure when the cancer of the tongue is fully developed is due to the neglect to remove the muscles of the floor of the mouth below the cancer.
"The high mortality after operations for cancer of the tongue is chiefly due to the removal of the floor of the mouth without removing at the same time a section of the lower jaw.
"When the operation is performed in one stage, it is impossible to remove the tongue, the floor of the mouth, the glands, and then close the opening in the mouth unless a section of the lower jaw is also removed. If the former operation is done thoroughly, the mortality is very high-almost 80 percent-from primary or secondary pneumonia, or late infection from the oral fistula".
For moderately early cases Bloodgood recommends an operation done along the following lines: The glands of the neck are first thoroughly removed, and the floor of the mouth above the glands, but below the tongue, thoroughly burned with the cautery, and the wound closed. At a little later date the affected portion of the tongue and the floor of the mouth below it are attacked from above with the cautery until the two areas of cauterization meet. The healed skin flap from the first operation forms the floor of the mouth and prevents infection from without.
In very late cases it is still necessary to remove a section of jaw, the tongue, floor of the mouth, and glands in a block operation.