Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients

Abstract

Introduction:Velopharyngeal insufficiency (VPI) is the inability to close the velopharyngeal sphincter during phonation and/or feeding. VPI is clinically characterised by hypernasal speech and nasal regurgitation. In cases of severe VPI, pharyngoplasty is recommended. Cases of mild-to-moderate VPI can be treated with fat grafting of the posterior pharyngeal wall in addition to speech therapy. The lipofilling can also be useful after pharyngoplasty to improve the outcomes.Materials and Methods:Twenty-one patients (14 males and 7 females), ages 4–23 affected by mild-to-moderate VPI and treated with lipofilling were included in this retrospective study. The mean injected fat volume was 7.95 cc (median 6 cc, min 4 cc, max 20 cc and range 16 cc). The follow-up ranged from 6 to 60 months. The pre- and post-operative Borel–Maisonny scores were compared using Wilcoxon test. Moreover, we performed a telephone survey with the aim to assess the parental perception on child's speech and quality of life after the surgical treatment.Results:Despite the small sample size, in this case series, we observed a statistically significant Borel–Maisonny score improvement and a parental satisfaction rate of about 85%.Conclusions:The augmentation of the posterior pharyngeal wall in addition to speech therapy improved the Borel–Maisonny score and the intelligibility of this case series of patients affected by mild-to-moderate VPI. In these patients, evaluated in a multidisciplinary approach, this technique allowed us to avoid major surgical procedures that would modify the anatomy of the velopharyngeal port. However, prospective comparative studies or randomised controlled trials could be useful to compare fat grafting with velopharyngoplasty techniques, with the aim to clarify indications and to define a specific treatment protocol.

Autologous Fat Grafting in Velopharyngeal Insufficiency Gives Complete and Stable Speech Recovery in Patient Under 7 years.

“…Cantarella 16 Cao 17 Bishop 22 Piotet 24 Nigh 28 Panizza 33 Adams 36 Denadai 43 Klotz 7 Leboulanger 12 Rossleigh 18 Filip 23 Mazzola 25 Dinsever 29 Phua 34 Abdali 37 Cantarella 44 Cantarella 13…”

Autologous Fat Injection Pharyngoplasty in Adults with Velopharyngeal Insufficiency

“…Future studies would benefit from structured, validated measures, such as Borel-Maisonny nasalance scores and Pittsburgh Weighted Speech Scale. 8,9 Furthermore, our patients were compared against their preoperative status, rather than using a control group. To our knowledge, none of the aforementioned ideal measures have been performed in an adult, noncleft population, and this limited case series remains a significant contribution to the current literature.…”

Applications of Fat Grafting in Pediatric Patients

“…49 While traditional surgical treatment options may be associated with more risks, they have favorable functional outcomes and are recommended for severe cases of velopharyngeal insufficiency. 6,49 In summary, autologous fat grafting into the velum is a safe, effective, and minimally invasive treatment strategy for select groups of patients with mild velopharyngeal insufficiency. 6,49…”

“…6,49 In summary, autologous fat grafting into the velum is a safe, effective, and minimally invasive treatment strategy for select groups of patients with mild velopharyngeal insufficiency. 6,49…”

“…[2][3][4][5] In addition, its applications in the management of scars and functional deficiencies related to velopharyngeal insufficiency have also been described. 2,6 Despite increasing popularity of autologous fat grafting in the pediatric population, pediatric fat grafting faces many of the same challenges seen in adults, with the most notable being unpredictable resorption rates. 2,7 Moreover, at present, the literature on fat grafting in the pediatric setting is sparse, and data on long-term outcomes and graft survival rates remain limited.…”