A 73-year-old gentleman who previously had a left soft palate squamous cell carcinoma (SCC), treated with concurrent chemoradiotherapy, presented with a 5-month history of throat discomfort associated with weight loss. Subsequent biopsy confirmed a recurrent SCC involving the left soft palate, left oropharyngeal wall and tongue base.

He underwent a salvage left oropharyngectomy, partial epiglottectomy and excision of soft palate via a mandibulotomy approach, with a concurrent radial forearm free flap (RFFF) reconstruction. At the time of surgery, a pharyngoplasty was performed utilising the remnant pharyngeal muscles, and a PEG tube was inserted. A videofluoroscopy swallow study informed an intensive 10-week dysphagia program comprised of intensive bolus-driven therapy following the protocol that is routinely used in our institution [2]. Despite initial gains, over the next 18 months, there was a progressive atrophy of the volume of the RFFF, resulting in two episodes of clinically significant aspiration pneumonias requiring hospital admission.

Laryngoscopic examination revealed incomplete contact of the tongue base to the neo-pharyngeal wall. We hypothesised that increasing the volume of the RFFF will allow better contact of the tongue base to the neo-pharyngeal wall. Hence, the patient was consented to a fat transfer to the oropharynx via a liposuction fat harvest. Thirty cubic centimetres of fat was harvested from the abdominal fat and infiltrated into the RFFF at the posterior and left oropharynx wall, as well as the soft palate.

One week prior to, and day one post- surgery, a speech pathologist assessed his intraoral anterior, medial and posterior tongue pressure using the Iowa Intraoral Performance Instrument (IOPI); the results of which were correlated to instrumental assessments (fibreoptic endoscopic evaluation of swallowing; FEES), patient and clinician-reported outcome measures.

The primary outcome measures were instrumental assessments using the IOPI and FEES. IOPI readings were taken from the anterior, middle, and posterior oral cavity.