Autologous fat transfer in velopharyngeal insufficiency: Indications and results of a 25 procedures series

Leboulanger, Nicolas; Blanchard, M.; Denoyelle, Françoise; Glynn, Fergal; Charrier, Jean-Baptiste; Roger, G.; Monteil, Jean-Paul; Eréa-Noël, Garabedian

doi:10.1016/j.ijporl.2011.08.001

Cited by 37 publications

(12 citation statements)

References 21 publications

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“…have previously demonstrated clinical improvement of chronic radiation-induced fibrosis following injection of processed autogenous lipoaspirate beneath fibrotic skin. [ 39 ] AFG was also widely used in laryngoplasy,[ 40 ] dural defect repair,[ 41 ] prostate-perineal fistula closure, and treating, etc.…”

Section: Discussionmentioning

confidence: 99%

A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications

Huang

Zhang

et al. 2015

Chinese Medical Journal

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Objective:Clinical application of autologous fat grafting (AFG) is quickly expanding. Despite the widely acceptance, long-term survival rate (SR) of AFG remains a question not yet solved. Meanwhile, although rare, severe complications related to AFG including vision loss, stroke even death could be seen in the literature.Data Sources:A comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology. Articles were screened using predetermined inclusion and exclusion criteria.Study Selection:Data collected included patient characteristics, surgical technique, donor site, recipient site, graft amount, and quantified measurement methods. Patient cohorts were pooled, and SR was calculated. All the severe complications were also summarized according to the different clinical characteristics.Results:Of 550 articles, 16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods. Totally, 596 patients were included. SR varied from 34% to 82% in breast and 30–83% in the facial area. Nude mice were applied to investigate human fat grafting SR (38.3–52.5% after 15 weeks). Rabbits were commonly used to study animal AFG SR (14.00–14.56% after 1-year). Totally, 21 severe complications were reported, including death (2), stroke (10), vision loss (11, 8 of which accompanied with stroke), sepsis (3), multiple abscess (1) and giant fat necrotic cyst (2). Ten of these complications happened within 10 years.Conclusions:There is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite. Body mass index change between pre- and postoperation may be the bias factor in evaluating fat SR. Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.

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Section: Discussionmentioning

confidence: 99%

A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications

Huang

Zhang

et al. 2015

Chinese Medical Journal

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“…The goals of the augmentation of the posterior wall of the pharynx with the lipofilling are to improve voice resonance and correct nasal air escape by reducing the velopharyngeal gap. As reported in the literature,[ 1 2 3 4 5 6 7 8 ] the lipofilling allows to create a neo-Passavant's pad improving the intelligibility of the speech in cases of mild-to-moderate VPI. This technique has been reported to have good results since the first published works of Dejonckere in 2001[ 9 ] and Bardot et al .…”

Section: Discussionmentioning

confidence: 99%

“…Other authors in 2011 published their experience of injection in the velum in the posterior and in the lateral pharyngeal walls without complications. [ 3 8 ] Cao et al . in 2013 described their technique of injection only in the posterior pharyngeal wall.…”

Section: Discussionmentioning

confidence: 99%

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

Panizza

Ghiglione

Zingarelli

et al. 2018

Indian J Plast Surg

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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.

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“…Several reports have described another method for treating VPI [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Velopharyngeal structure augmentation is an alternative to pharyngeal flap surgery that utilizes an injectable material implanted into the tissue around the velopharynx.…”

Section: Introductionmentioning

confidence: 99%

“…There have been no reports about the optimal materials for implantation or injection, however. There are various artificial and biological materials that may be used in the velopharyngeal structure, including silicone, Teflon, porous polyethylene, Gore-Tex 1 , calcium hydroxyapatite, auricular or costal cartilage, and autologous fat [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. However, when we augment the soft palate, the material needs to be injectable, because it cannot be implanted into the nasal side of the soft palate without damaging the levator veli palatini.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic soft palate augmentation using injectable materials in dogs to ameliorate velopharyngeal insufficiency

et al. 2020

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Background Velopharyngeal structure augmentation methods are used as alternatives to pharyngeal flap operations. Recently, we investigated the sites of velopharyngeal structure augmentation in dogs and reported that the most effective injection location is the soft palate. However, there have been no reports regarding the optimal materials for implantation or injection. In this study, we aimed to investigate the injectable materials used in soft palate augmentation in dogs to ameliorate velopharyngeal insufficiency (VPI). Methods Endoscopic soft palate augmentation (ESPA) was performed in dogs using purified sodium hyaluronate, atelocollagen, or autogenic fat tissue. ESPA is an original technique developed by our group, and this is the first report of its performance. Moreover, we assessed the amount of nasal air leakage during inspiration at rest and during expiration under the rebreathing system at 1, 2, 3, 4, 5, and 6 months after injection of these materials. Results The amount of nasal air leakage during expiration under the rebreathing system was significantly decreased in all dogs injected with the ESPA materials, but neither apnea nor hypopnea was observed. Conclusions We investigated the optimal materials for use in ESPA, such as purified sodium hyaluronate, atelocollagen, or autogenic fat tissue. We found that all of them reduced nasal air leakage and only autogenic fat tissue showed significant histologic differences in dogs at 6 months. This technique may also be useful for the treatment of patients with VPI.

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Autologous fat transfer in velopharyngeal insufficiency: Indications and results of a 25 procedures series

Cited by 37 publications

References 21 publications

A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications

A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications

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

Endoscopic soft palate augmentation using injectable materials in dogs to ameliorate velopharyngeal insufficiency

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