In‐Office Injection Pharyngoplasty for Velopharyngeal Insufficiency After Oropharyngeal Cancer Treatment

O’Dell, Karla; Hubanks, J. Mikel

doi:10.1002/lary.27853

Cited by 3 publications

(2 citation statements)

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“…This is particularly relevant in paediatric patients and if fat harvest and preparation are considered. On the basis of the adopted practice of in-office injection laryngoplasty for glottic insufficiency, O’Dell et al [15] recently described in-office awake injections of micronized Alloderm in four patients with acquired VPI after treatment of oropharyngeal carcinoma. During this procedure, the patient's velopharyngeal closure was tested, and additional material was injected as needed.…”

Section: Surgical Protocolsmentioning

confidence: 99%

“…Review of the current literature reveals wide variation in patient selection among paediatric [5] and adult patients [3], with regard to both demographics and VPI cause (i.e. congenital (craniofacial, syndromic) versus iatrogenic (adenoidectomy, postoropharyngeal oncologic resection) [15] and spontaneous versus stress-induced VPI (i.e. musicians who play wind instruments)) [16].…”

Section: Patient Selectionmentioning

confidence: 99%

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Update on injection augmentation pharyngoplasty in the treatment of velopharyngeal insufficiency

Kelly

Nassar

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Velopharyngeal insufficiency (VPI) refers to a structural defect resulting in incomplete closure between the soft palate and posterior pharyngeal wall, leading to inadequate speech and deglutition. Traditional surgical options for VPI include sphincter pharyngoplasty, pharyngeal flaps and palatoplasty. Although these procedures have been successfully used over the past several decades, they are associated with complications such as pain, bleeding, infection and obstructive sleep apnoea. They also require postoperative admission. Injection augmentation pharyngoplasty (IAP) is increasingly being viewed as a viable, less invasive surgical option for patients with mild to moderate VPI. Recent findings Both autologous fat and alloplastic synthetics have been used as injectable materials, with low morbidity and good speech outcomes. However, given the overall lack of standardization across studies, no single material has shown clear superiority. Summary IAP is a promising alternative to more invasive surgeries in the treatment of patients with mild to moderate VPI. The purpose of this review is to provide an overview of this approach, with an emphasis on its safety and efficacy.

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Section: Surgical Protocolsmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Update on injection augmentation pharyngoplasty in the treatment of velopharyngeal insufficiency

Kelly

Nassar

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Efficacy of Posterior Pharyngeal Wall Injection for Velopharyngeal Dysfunction in Adults

Arora,

Young,

Schneider

et al. 2024

The Laryngoscope

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Objective(s)Posterior pharyngeal wall (PPW) injection is often employed to treat velopharyngeal deficiency (VPD). We sought to analyze the impact of PPW injection on severity of dysphagia and dysphonia.MethodsRetrospective chart review was conducted of patients undergoing PPW injection from 2018 to 2023 at a tertiary laryngology center. Effects on Voice Handicap Index‐10 (VHI‐10), Eating Assessment Tool‐10 (EAT‐10), soft palate closure on modified barium swallow, and auditory‐perceptual measures of hypernasality and audible nasal air emission were analyzed.Results67 PPW injections were performed in 29 patients (11 female). Mean age was 59.4 ± 17.0 years. Etiologies were head and neck cancer (n = 23) and neurologic conditions (n = 6). 30 PPW injections were performed concurrent with intervention on the upper esophageal sphincter (25 dilations, 3 myotomies, 2 botulinum toxin injections), and 8 with a glottic procedure (6 vocal fold injections, 2 thyroplasties). Change scores were 3.87 (−6.85 to −0.89, p = .012) for VHI‐10 and −3.00 (−4.75 to −1.25, p = 0.001) for EAT‐10. These were statistically different from 0 for the whole cohort but not in the subset of patients undergoing concurrent voice and/or swallow surgery. Soft palate closure scores tended to be better (but not statistically significant) on MBS after PPW injection. Hypernasality and audible nasal air emission both improved after injection.ConclusionPPW injection appears to have a therapeutic effect on dysphagia/dysphonia in patients with VPD; however, many patients have multifactorial impairment. Additional study is needed to determine benefit of PPW when performed in conjunction with other procedures in this complex patient population.Level of EvidenceLevel 4 (Case series) Laryngoscope, 2024

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Evaluation and Management of Speech and Swallowing Issues in RFS

Ebersole

McMillan

Hutcheson

2023

Curr Phys Med Rehabil Rep

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In‐Office Injection Pharyngoplasty for Velopharyngeal Insufficiency After Oropharyngeal Cancer Treatment

Cited by 3 publications

References 20 publications

Update on injection augmentation pharyngoplasty in the treatment of velopharyngeal insufficiency

Update on injection augmentation pharyngoplasty in the treatment of velopharyngeal insufficiency

Efficacy of Posterior Pharyngeal Wall Injection for Velopharyngeal Dysfunction in Adults

Evaluation and Management of Speech and Swallowing Issues in RFS

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