Functional Base of Tongue Fat Injection in a Patient with Severe Postradiation Dysphagia

Abstract

Lipofilling is a well-established technique in reconstructive plastic surgery. It is used primarily in recontouring of the body and face to correct post-traumatic and congenital defects. The regenerative properties of adipose tissue have allowed the use of the lipofilling technique for the treatment of burn sequelae and irradiated breast to improve tissue quality and elasticity. We report on the case of a patient treated with radiation therapy for a nasopharyngeal carcinoma who presented with severe postradiation dysphagia. The lipofilling technique was successfully used to improve abnormal swallowing. The technical details and functional outcomes are discussed.

Feasibility and potential value of lipofilling in post‐treatment oropharyngeal dysfunction

“…Adipose tissue is extremely suitable for filling tissue defects because it is autologous and homogeneous in consistency, preventing possible graft‐versus‐host reactions, as opposed to artificial fillers that may have complications . Nevertheless, it remains difficult to predict how much fat will be resorbed and thus how long a therapeutic effect will persist .…”

“…Adipose tissue is extremely suitable for filling tissue defects because it is autologous and homogeneous in consistency, preventing possible graft-versus-host reactions, as opposed to artificial fillers that may have complications. [11][12][13][14] Nevertheless, it remains difficult to predict how much fat will be resorbed and thus how long a therapeutic effect will persist. 16 With the Coleman technique, absorption of fat seems to be reduced as much as possible 13,17 ; however, three or more repeats are probably necessary to achieve and hold a therapeutic effect.…”

“…12,13 To date, except for skin contouring indications, 13 lipofilling is rarely used in HNC as there is, to the best of our knowledge, only one case history published about this technique being applied to treat oropharyngeal dysfunction following treatment for HNC. 14 In that study, lipofilling filled the existing defect in the vallecula that was the cause of significant stagnation of the food bolus, and the added volume elevated the epiglottis and thus improved airway protection. In the present study, the feasibility and potential value of lipofilling in seven HNC patients with chronic, therapy-refractory dysphagia was prospectively assessed.…”

“…Common indications are tissue loss, pain, and/or fibrosis due to surgery, irradiation, burns, or other (post‐traumatic) causes . To date, except for skin contouring indications, lipofilling is rarely used in HNC as there is, to the best of our knowledge, only one case history published about this technique being applied to treat oropharyngeal dysfunction following treatment for HNC . In that study, lipofilling filled the existing defect in the vallecula that was the cause of significant stagnation of the food bolus, and the added volume elevated the epiglottis and thus improved airway protection.…”

Fat grafting rescues radiation-induced joint contracture

“…Superior outcomes are found when grafted fat is enriched with adipose‐derived stromal cells (ASCs) (“cell‐assisted lipotransfer”) implicating ASCs as the key drivers of tissue regeneration . Few reports have described the beneficial effects of fat grafting in irradiated tissue on function: fat grafts injected into the base of the tongue may ameliorate severe dysphagia in patients irradiated for nasopharyngeal carcinoma; and fat injections into the irradiated subcutaneous tissue of patients with head and neck cancer can improve phonation and swallowing up to 2 years post‐RT . We therefore adapted a mouse model for radiation‐induced soft tissue fibrosis to induce limb contracture and explored whether fat grafting may have a therapeutic effect in this setting.…”