Functional fat injection under local anesthesia to treat severe postsurgical dysphagia, case report

Ottaviani, F.; Schindler, Antonio; Klinger, Francesco; Scarponi, Letizia; Succo, Giovanni; Mozzanica, Francesco

doi:10.1002/hed.25465

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…Martin-Harris and colleagues have investigated the effect of a respiratory-swallowing training in patients with head and neck cancer treated with different modalities and chronic dysphagia and have reported an improvement in the laryngeal closure and the tongue base retraction, associated with a reduction of lower airways’ invasion and pharyngeal residue [36]. As for laryngeal closure, fat injections have been proposed in patients who underwent an OPHL type I for the correction of the tissue loss at the level of the base of tongue, with promising results on the improvement of the swallowing efficiency [37,38].…”

Section: Discussionmentioning

confidence: 99%

Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study

Pizzorni

Schindler

Castellari

et al. 2019

Cancers

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Dysphagia is common after an open partial horizontal laryngectomy (OPHL). The mechanisms causing lower airways’ invasion and pharyngeal residue are unclear. The study aims to examine physio-pathological mechanisms affecting swallowing safety and efficiency after OPHL. Fifteen patients who underwent an OPHL type IIa with arytenoid resection were recruited. Videofluoroscopic examination of swallowing was performed. Ten spatial, temporal, and scalar parameters were analyzed. Swallowing safety and efficiency were assessed through the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Swallowing was considered unsafe or inefficient for a DIGEST safety or efficiency grade ≥2, respectively. Videofluoroscopic measurements were compared between safe vs. unsafe swallowers, and efficient vs. inefficient swallowers. Seven patients (46.7%) showed unsafe swallowing and 6 patients (40%) inefficient swallowing. Unsafe swallowers had worse laryngeal closure (p = 0.021). Inefficient swallowers presented a longer pharyngeal transit time (p = 0.008), a reduced pharyngoesophageal segment opening lateral (p = 0.008), and a worse tongue base retraction (p = 0.018 with solids and p = 0.049 with semisolids). In conclusion, swallowing safety was affected by incomplete laryngeal closure, while swallowing efficiency was affected by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and incomplete tongue base retraction. The identified physio-pathological mechanisms could represent targets for rehabilitative and surgical approaches in patients with dysphagia after OPHL.

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Section: Discussionmentioning

confidence: 99%

Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study

Pizzorni

Schindler

Castellari

et al. 2019

Cancers

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“…These three studies showed that lipofilling might be an effective treatment for HNC patients with chronic dysphagia. No complications were reported, and therefore, lipofilling seems safe [38,49,50]. Many patients showed improved objective and subjective swallowing function after lipofilling.…”

Section: Short-term Outcomesmentioning

confidence: 86%

“…In the last few years, different studies, primarily case reports, have been published about the use of lipofilling in patients with chronic dysphagia due to HNC (treatment) [38,49,50]. Navach et al [49] reported about a 58-year-old patient with impaired swallowing after treatment for a nasopharyngeal carcinoma.…”

Section: Short-term Outcomesmentioning

confidence: 99%

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Lipofilling in Post-Treatment Oral Dysfunction in Head and Neck Cancer Patients

Neijman¹,

Karsten²,

Molen³

et al. 2022

Dysphagia - New Advances

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Lipofilling is a new treatment option for head- and neck cancer patients who suffer from chronic and severe (chemo-) radiation or surgery-related swallowing problems. Lipofilling is a technique of autologous grafting in which living fat cells are transplanted from one location to another in the same patient. In the case of head and neck cancer patients, volume loss or muscle atrophy of the tongue or pharyngeal musculature caused by the treatment may result in oropharyngeal dysfunction. Firstly, intensive swallowing therapy will be given, but if that offers no further improvement and the functional problems persist, lipofilling can be considered. By transplantation of autologous adipose tissue, the functional outcomes might improve by compensating the existing tissue defects or tissue loss. Only a few studies have been published which evaluated the effectiveness of this new treatment option. The results of those studies show that the lipofilling technique seems safe and of potential value for improving swallowing function in some of the included patients with chronic and severe dysphagia after surgery and/or (chemo-) radiation therapy for head and neck cancer. The lipofilling procedure will be described in detail as well as the clinical implications.

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“…Crary et al (7) originally suggested the adult FOIS for stroke patients. Afterwards, other researchers expanded the FOIS for patients with traumatic brain injury (31, 32), head and neck cancer (33, 34), vocal fold immobility (35), vagal schwannoma resection (36), cerebral palsy (37), postsurgical dysphagia (38), neurodegenerative diseases (39), postextubation dysphagia in children (40), and neurogenic dysphagia (41). The FOIS for infants suggested in the present study was a simplified scale with levels reduced from 7 to 5, without taking into account the concepts of single/multiple consistency food, special preparation or compensation, and food restriction.…”

Section: Study Limitationsmentioning

confidence: 99%

Psychometrics of the Functional Oral Intake Scale for Infants

Shin

2019

Front. Pediatr.

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This study aimed to investigate the reliability and validity of the Functional Oral Intake Scale (FOIS) for infants. Infants (age, <1 year) who underwent a videofluoroscopic swallowing study (VFSS) were included in this retrospective study. Their nutrition records at the time of the VFSS were separately evaluated by two raters using the five-point FOIS for infants. Categorical swallowing and aspiration impairment scale data were also obtained from the VFSS. The inter-rater reliability of the FOIS for infants was high (95.5% absolute agreement) among the 201 evaluated infants, and this scale was significantly correlated with aspiration severity in the VFSS. We also investigated whether infants with partial oral feeding (POF) at the FOIS evaluation had achieved full oral feeding within 1 year of the evaluation and used this information to estimate whether the caloric contribution, as well as consistency of oral feeding, affected the feeding outcomes. This analysis included 33 infants who were receiving both oral and tube feeding (i.e., POF). Among them, 26 infants achieved full oral feeding (FOF) without tube feeding after 1 year. Their initial contribution from oral feeding was higher than that in infants who still maintained POF after 1 year (28.46 ± 22.79 vs. 6.00 ± 5.45%, p < 0.001). The five-point FOIS for infants, which reflected the expansion of their oral diet with growth, had adequate reliability and validity. The caloric contribution as well as consistency of oral feeding could be used to distinguish FOIS levels 2 and 3, which correspond to the POF status in infants.

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Functional fat injection under local anesthesia to treat severe postsurgical dysphagia, case report

Cited by 7 publications

References 13 publications

Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study

Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study

Lipofilling in Post-Treatment Oral Dysfunction in Head and Neck Cancer Patients

Psychometrics of the Functional Oral Intake Scale for Infants

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