Augmentation pharyngoplasty for treatment of velopharyngeal insufficiency in children: Results with injectable dextranomer and hyaluronic acid copolymer

Abstract

4 Laryngoscope, 126:S5-S13, 2016.

Treatment of Stress Velopharyngeal Incompetence With Injection of Hyaluronic Acid

“…There were no complications or negative side effects reported in this patient. This is consistent with a recent report of children with VPI who were treated with hyaluronic acid pharyngoplasty; their series experienced only minor side effects (Cofer et al, 2016).…”

“…The most common surgical options are sphincter pharyngoplasty and pharyngeal flap surgery (Malick et al, 2007). Other options include lipoinjection of the soft palate and injection to the posterior pharyngeal wall, which have also shown positive patient outcomes (Cofer et al, 2016; Dibbell et al, 1979; Klotz et al, 2001; Malick et al, 2007; Raol et al, 2015; Visser and van der Biezen, 2012). Injections are utilized primarily for small midline gaps, but may be less effective for larger and more lateral gaps because injected material has greater potential for migration.…”

“…Management options include the same as those for speech VPI, such as speech therapy, palatoplasty, sphincter pharyngoplasty, pharyngeal flap surgery, and injection pharyngoplasty (Cofer et al, 2016; Dibbell et al, 1979; Malick et al, 2007; Raol et al, 2015). Augmentation of the posterior pharyngeal wall with an injectable material has been described previously with materials such as Teflon and calcium hydroxyapatite with varying levels of success (Gordon et al, 1994; Raol et al, 2015).…”

“…Injection of hyaluronic acid compounds has been described for vocal cord paralysis and type 1 laryngeal clefts (Mangat and El-Hakim, 2012; Reiter and Brosch, 2012) and, more recently, a series of children with VPI (Cofer et al, 2016). We describe a case of a preprofessional clarinetist with stress VPI who was successfully treated with posterior wall augmentation with a hyaluronic acid compound.…”

Hyaluronic acid augmentation pharyngoplasty complicated by retropharyngeal abscess and grisel syndrome: Case report and literature review

“…Precautions to be considered (to avoid this kind of complications) 1 : A small caliber needle should be used (25‐gauge needle). 2 Injection should be superficial at the level of pharyngeal constrictor muscles and para‐vertebral fascia targeting retropharyngeal soft tissue 3 .…”