Stone Fort and Pits on the Inyanga Estate, Rhodesia

Hall, Richard

doi:10.2307/2843119

Cited by 2 publications

(1 citation statement)

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“…Existing literature describing AFG in the head and neck region has reported instances of iatrogenic cerebrovascular accidents resulting from intravascular injection, thereby raising concerns regarding its safety 52–56 . To minimize the risk of fat embolism in AFG to the velopharynx specifically, a thorough preoperative protocol has been suggested 51 .…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%