Pharyngeal tongue base augmentation for dysphagia therapy: A prospective case series in patients post head and neck cancer treatment

Abstract

Background: Dysphagia post head and neck cancer (HNC) multimodality treatment is attributed to reduced pharyngeal strength. We hypothesized that pharyngeal tongue base augmentation for dysphagia (PAD therapy) would increase pharyngeal pressures during swallowing thereby improving swallow symptoms. Methods: Adults with moderate-severe dysphagia post-HNC treatment had PAD therapy using a temporary filler (hyaluronic acid [HA]), with follow-up long-lasting lipofilling. Swallowing preprocedure and postprocedure was assessed with the Sydney Swallow Questionnaire (SSQ), High-Resolution Pharyngeal Manometry (HRPM), and Videofluoroscopic Swallowing Study (VFSS). Statistical comparison utilized paired tests. Results: Six participants (all male; median age 64 years [IQR 56, 71]) underwent PAD therapy at a median of 47 [IQR 8, 95] months post-treatment. SSQ scores reduced from baseline (mean 1069 [95%CI 703, 1434]) to post-HA (mean 579 [76, 1081], p > 0.05), and post-lipofilling (491 [95%CI 913, 789], p = 0.003, n = 4). Individual participants demonstrated reduced Swallow Risk Index, Bolus Presence Time, and increased Upper Esophageal Sphincter opening, but mesopharyngeal contractile pressures were unchanged. VFSS measures of aspiration, residue, and severity were unchanged.Conclusions: Novel PAD therapy is safe and improves dysphagia symptoms.Biomechanical swallowing changes are suggestive of more efficacious bolus propulsion with conservative filler volume, but this was unable to resolve residue or aspiration measures.

Tongue base augmentation to improve swallow function in a cadaveric model

“… 6 , 9 In 2022, Schar et al, described a novel surgical treatment which uses hyaluronic acid and lipofilling for pharyngeal tongue base augmentation. 10 They report increased pharyngeal pressure and improved dysphagia symptoms postoperatively. In this case report, we examine the feasibility of tongue base augmentation with CaHA to decrease pharyngeal area and improve lingual‐palatal apposition.…”

“…More recently, cell therapy with autologous myoblasts for radiation induced tongue atrophy has been investigated 6,9 . In 2022, Schar et al, described a novel surgical treatment which uses hyaluronic acid and lipofilling for pharyngeal tongue base augmentation 10 . They report increased pharyngeal pressure and improved dysphagia symptoms postoperatively.…”

Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders

“…Current recommendations on P‐HRM‐I assessments of oro‐pharyngeal swallowing include guidance on deriving eight physiological measures that define pharyngeal contractile vigor as well as UES pressure relaxation and opening 8 . These parameters have already been helpful for characterizing the physiological and potential rehabilitative effects of swallowing exercise, 9,10 sensory stimulation, 11 and novel surgical interventions 12,13 . These measurements can complement routine clinical and instrumental swallowing assessments by adding understanding of the pathophysiology of dysphagia that may help guide patient management.…”

“…8 These parameters have already been helpful for characterizing the physiological and potential rehabilitative effects of swallowing exercise, 9,10 sensory stimulation, 11 and novel surgical interventions. 12,13 These measurements can complement routine clinical and instrumental swallowing assessments by adding understanding of the pathophysiology of dysphagia that may help guide patient management. However, further evidence is required to objectively confirm that P-HRM-I assessments can differentiate disordered swallowing in patients from normal swallowing in asymptomatic controls and/or differentiate patients who are at aspiration risk from those who swallow safely.…”