Posterior Pharyngeal Augmentation in the Treatment of Velopharyngeal Insufficiency

Abstract

Augmentation of the posterior pharyngeal wall is a safe and effective treatment for patients with VPI. Implants are well tolerated and speech is substantially improved.

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

“…Lypka et al has the largest series on posterior pharyngeal wall augmentation. They investigated posterior wall augmentation using silicone and Gor‐Tex implants in 111 pediatric patients over a 40‐year period . Seventy‐three percent of their patients achieved near‐normal speech.…”

“…Seventy‐three percent of their patients achieved near‐normal speech. Excluding the patients lost to follow‐up, improvement was seen in nearly all patients (98%) . Injection augmentation is simpler than implants, and new materials including acellular micronized dermis and calcium hydroxyapatite have been described .…”

“…This is not an appropriate treatment for those patients with larger defects for which a local rotational flap, free flap, or obturator would be necessary. Posterior wall augmentation has been shown to be most effective for patients with good palatal movement and velopharyngeal gaps of up to 5 mm . In‐office posterior pharyngeal augmentation is a procedure that can be used for those patients with mild defects and VPI symptoms.…”

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

“…When ST does not achieve a sufficient improvement on speech or on nasal aspirations, surgery may be indicated. Several surgical strategies have been described over the years (apart from cleft reconstruction): sphincter pharyngoplasty, palatal pushback, velopharyngoplasty (VPP) with posterior pharyngeal flap, pharyngeal posterior wall augmentation with Vaseline [3], Teflon [4], implants [5], cartilage [6,7], muscular flap [8], hydroxyapatite [9,10], and autologous fat transfer (AFT) [3,[11][12][13][14].…”

Fat Injections for the Treatment of Velopharyngeal Insufficiency

“…Velopharyngeal insufficiency is most frequently due to congenital abnormalities of the palate and is mainly a sequela of cleft palate repair; other potential etiologies are neurologic causes (paralysis or paresis) or acquired conditions. 3,4 Augmenting the posterior pharyngeal wall by means of implants or reabsorbable materials has been proposed as an alternative to major surgical procedures over the years, 5,6 but the main limitations of implants are related to their migration and extrusion and foreign body reaction, 7 and reabsorbable materials only lead to temporary improvement. 1 The results of velopharyngoplasties are excellent in reducing hypernasality and improving voice resonance and speech articulation; however, they may cause considerable postoperative morbidity in terms of pain and bleeding.…”