Treatment of velopharyngeal insufficiency by autologous fat injection

Abstract

Velopharyngeal insufficiency (VPI) is a structural or functional trouble, which causes hypernasal speech. Velopharyngeal flaps, speech therapy and augmentation pharyngoplasty, using different implants, have all been used to address this trouble. We hereby present our results following rhinopharyngeal autologous fat injection in 18 patients with mild velopharyngeal insufficiency (12 soft palate clefts, 4 functional VPI, 2 myopathy). 28 injections were carried out between 2004 and 2007. The degree of hypernasal speech was evaluated pre- and postoperatively by a speech therapist and an ENT specialist and quantified by an acoustic nasometry (Kay Elemetrics). All patients were exhaustively treated with preoperative speech therapy (average, 8 years). The mean value of the nasalance score was 37% preoperatively and 23% postoperatively (p = 0.015). The hypernasality was reduced postoperatively in all patients (1-3 degrees of the Borel-Maisonny score). There were no major complications, two minor complications (one hematoma, one cervical pain). The autologous fat injection is a simple, safe, minimally invasive procedure. It proves to be efficient in cases of mild velopharyngeal insufficiency or after a suboptimal velopharyngoplasty.

Adipose-derived regenerative cell (ADRC)-enriched fat grafting: optimal cell concentration and effects on grafted fat characteristics

“…Autologous free fat grafting is a widely accepted technique used for the correction of various soft-tissue defects because it is biocompatible, versatile, natural-looking, non-immunogenic, inexpensive, and readily obtainable with low donor site morbidity [1,2]. Although free fat grafting is used as a method for soft tissue reconstruction, absorption of the fat after grafting is problematic.…”

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

“…Dejonckere [3,12,22]. All studies reported good results, but only Leuchter's used Borel-Maisonny scale as clinical criteria, making a comparison possible.…”

“…AFT has been proposed for treatment of VPI since the beginning of the 20th century [3], but there is sparse evidence in the literature Objective: To assess the efficiency of autologous fat transfer (AFT/Coleman procedure) in the management of velopharyngeal insufficiency (VPI). Settings: Tertiary academic center, retrospective case series over a 4 year period.…”

“…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

“…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. 9 Fat grafting in the posterior pharyngeal wall using an external approach was originally described by Gaza 10 in 1926. 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.…”