Investigation of the speech results of posterior pharyngeal wall augmentation with fat grafting for treatment of velopharyngeal insufficiency

Elikucuk, Cagla Dinsever; Kayikci, Mavis Emel Kulak; Aydınlı, Fatma Esen; Çalış, Mert; Özgür, Figen; Öztürk, Mehtap; Günaydın, Rıza Önder

doi:10.1016/j.jcms.2017.02.024

Cited by 16 publications

(13 citation statements)

References 27 publications

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“…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…”

Section: Surgical Proceduresmentioning

confidence: 99%

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

Suzzi

Baylon

Tramini

et al. 2021

Journal of Craniofacial Surgery

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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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Section: Surgical Proceduresmentioning

confidence: 99%

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

Suzzi

Baylon

Tramini

et al. 2021

Journal of Craniofacial Surgery

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“…[ 22 ] Lipofilling for the treatment of VPI has been proposed since 2001 and at our knowledge in the literature are present 13 published articles. [ 1 10 23 24 25 ] All the cited studies reported good results, and despite the potential major risks (obstructive sleep apnoea, fat embolism and/or injuries to the internal carotid artery), many authors insist on the safety of the procedure and on the possibility of its repetition in case of partial improvement.…”

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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“…Injection site was reported in 18 studies, all of which stated single-and/or multisite injections for AFG. Injection sites were delineated as 1) PPW, [27][28][29][31][32][33][34][35][36][37][38]44 2) SP, 2,40,41 3) PPW + SP, 27,30 4) PPW + lateral pharyngeal wall (LPW), 27 5) PPW + LPW + SP, 27 6) PPW + SP + peritonsillar arch, 39 and 7) PPW + SP + palatopharyngeal arch. 2,43 Mean volume of fat injected was reported in 14 out of 20 studies, averaging 6.3 mL per patient (range 2.4-13.1 mL).…”

Section: Patient and Surgical Intervention Characteristicsmentioning

confidence: 99%

“…30 Nasalance was evaluated preoperatively and postoperatively in four studies, totaling 126 patients. 30,35,38,44 This surgical outcome was reported as the mean difference in nasalance (%) prior to and after AFG, with time of follow-up evaluation differing by study. In Piotet et al, a 9% mean improvement in nasalance was seen in 15 out of 17 patients, all measured within 2 months of the last injection.…”

Section: Nasalancementioning

confidence: 99%

“…[24][25][26] Existing literature has expressed support for AFG as a safe and effective treatment for mild to moderate cases for VPI. 2,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] However, varied indications, techniques, and measured outcomes between studies have led to lack of universal acceptance. 18,19 Additionally, inconsistent reporting of critical data related to patient and surgical intervention characteristics has further complicated data interpretation.…”

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confidence: 99%

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An Evaluation of Autologous Fat Injection as a Treatment for Velopharyngeal Insufficiency

Mirsky,

Slavin,

Sheinberg

et al. 2024

Ann Plast Surg

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Background Velopharyngeal insufficiency (VPI) is a condition characterized by incomplete separation of the oral and nasal cavities during speech production, thereby leading to speech abnormalities and audible nasal emissions. Subsequently, this adversely impacts communication and potentially interpersonal social interactions. Autologous fat grafting (AFG) to the velopharynx, a minimally invasive technique, aims to improve oronasal separation by providing bulk and advancing the posterior pharyngeal wall toward the soft palate. Despite its potential, the relative novelty of AFG in treating VPI has resulted in reporting of inconsistent indications, varied surgical techniques, and mixed outcomes across existing literature. Methods This systemic review examined the evidence of AFG for VPI treatment over the past decade (2013–2023). A thorough search across five electronic databases yielded 233 studies, with 20 meeting the inclusion criteria (e.g., utilized fat injection as their selected VPI treatment, conducted study in human subjects, did not perform additional surgical procedure at time of fat injection). Selected studies encompassed patient and surgical intervention characteristics, perceptual speech assessment (PSA) scores, gap sizes, nasalance measurements, and complications. Results The majority of patients had a prior cleft palate diagnosis (78.2%), in which nasoendoscopy was the prevalent method for visualizing the velopharyngeal port defect. Fat harvesting predominantly occurred from the abdomen (64.3%), with an average injection volume of 6.3 mL across studies. PSA and subjective gap size scores were consistently higher preoperatively than postoperatively. PSA score analysis from seven studies revealed significant and sustained improvements postoperatively. Gap size score analysis from four studies demonstrated similar preoperative and postoperative differences. Complications were reported in 17 studies, yielding a 2.7% summative complication rate among 594 cases. Conclusions Autologous fat grafting has emerged as a minimally invasive, safe, and effective treatment for mild to moderate VPI. However, challenges remain because of variability in patient selection criteria, diagnostic modalities, and outcome measurements. This review underscores the need for randomized control trials to directly compare AFG with standard-of-care surgical interventions, providing more conclusive evidence of its clinical efficacy.

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Investigation of the speech results of posterior pharyngeal wall augmentation with fat grafting for treatment of velopharyngeal insufficiency

Cited by 16 publications

References 27 publications

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

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

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

An Evaluation of Autologous Fat Injection as a Treatment for Velopharyngeal Insufficiency

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