*6.1.4 Short-term results*

A VFSS assessment showed improved scores for thick liquids (lower penetration and aspiration (PAS), see **Table 2**). This patient also reported notable improvement in subjective swallowing function, with substantially less effort and less choking. In **Figure 3**, the short-term post-lipofilling MRI scan is shown in the middle.


*Abbreviations: FOIS = functional oral intake scale: range 1–7, whereas 1 is 'no oral intake' and 7 means 'normal oral intake'; VFSS = video fluoroscopic swallowing study; PAS = penetration aspiration scale: range 1–8, lower scores mean better/safer swallowing function; TL = total laryngectomy; X = missing data; NA = not applicable (i.e., no transport possible); Post short\* = 1–3 months after lipofilling treatment; Post long\*\* = up to 4 years after lipofilling treatment.*

#### **Table 2.**

*Pre- and post-treatment outcomes after the lipofilling session.*

#### *6.1.5 Long-term results*

However, 2.5 years later the SWAL-QOL subscale scores deteriorated (see **Table 3**). Until 2020, this patient was able to maintain oral intake without a PRG. Swallowing was not easy, but he managed to have a full oral intake with additional diet modifications. He died in 2020 due to urosepsis. In **Figure 4**, the long-term post-lipofilling MRI scan is shown on the right.

**Figure 4.**

*MRI assessment of case 1 over time. On the left, pre-lipofilling injection. In the middle, short-term MRI (1 month post-treatment). On the right, long-term MRI (4 years post-treatment).*

#### **6.2 Case 2**

A 59-year-old female, was diagnosed with a T3N2c base of tongue tumor in 2004. Organ-preservation treatment with concurrent chemo radiotherapy resulted in a complete remission. In the post-treatment period, however, the patient developed severe dysphagia and dysarthria due to oropharyngeal scarring and base of tongue atrophy. Despite intensive swallowing rehabilitation with strengthening exercises, several esophageal dilatations, and a customized intraoral prosthesis lowering the

hard palate to also improve speech, the patient remained completely feeding tube dependent due to persistent oropharyngeal dysfunction/stagnation of food.
