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

Abstract

The authorspresent a retrospective observational cohort study of 47 French speaking consecutive patients treated with retropharyngeal wall filling with autologous fat graft from 2006 to 2019 in a single tertiary center, to assess with a longterm follow-up, the best tailored treatment to recovery speech for velopharyngeal insufficiency, and to stress the importance of early treatment with minimally invasive procedure with retropharyngeal wall fat grafting. In preoperative setting, a clinical and instrumental evaluation with aerophonoscope is completed by a palatal closure assessment with nasal endoscopy. All patients were classified according with Borel Maisonny score pre-and post-operatively. Sixty three fat injections were performed. In 4 cases a pharyngeal flap was performed after fat graft for an insufficient speech result. The authors had no complications. Patients with less than 7 years of age obtained a complete recovery of their velopharyngeal incompetence (P ¼ 0.03) compared to older patients. In conclusion, the authors can state that this tailored surgical technique needs a multidisciplinary approach. Many variables can affect postoperative results: fat reabsorption, concurrently performed surgery, pattern of pharyngeal closure, hearing impairment. None of these factors affected our result. Early treatment plays a crucial role to achieve better results. Patients with less of 7 years showed a better result in this functional treatment.

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“…Probably, after the 7th year, the compensatory mechanisms that parasitizing speech take on characteristics of irreversibility. The age of 7 years is confirmed as an important predictive factor of good result for grafting, 38 and now we confirm this result for the pharyngoplastic treatment too. In terms of failures or complication rate, AFG did not demonstrate complications, but it had a failure rate of 7.84%, resolved with a further pharyngoplasty with good results.…”

“…Palatine surgery was not considered among the variables, as it is an auxiliary and complementary surgical gesture of the speech driving surgery, [45][46][47][48] and we have shown in a previous work that this element does not change the results. 38 In the pharyngoplasty group, most of all received a superior pharyngeal flap de-scribed by Sanvenero Rosselli, only four patients were operated with an orticochea sphincteroplasty and we did not consider these patients independently. Secondly, one of the most important decision tools is in vivo findings obtained with NE, but our NE data was too descriptive to be used in a computational model.…”

“…We consider a stable result at 12 months postoperatively as demonstrated by Denadai 37 and another of our paper with a long follow-up. 38…”

“…We consider a stable result at 12 months postoperatively as demonstrated by Denadai 37 and another of our paper with a long follow-up. 38 Only if the speech result was insufficient, a postoperative NE is repeated, but not before six months from surgery.…”

“…Seven years was used as cutoff because this is a cutoff crucial age to achieve a good result, as we demonstrated in another paper. 38 The significance level used in the analysis was 5%. The objectives of the study were strictly exploratory; no formal statistical power analysis was performed.…”