Autologous Fat Injection for Treatment of Velopharyngeal Insufficiency

Abstract

Autologous fat injection offers a minimally invasive approach to the treatment of VPI. Current literature is limited to small noncomparative studies. These appear to suggest efficacy and safety in mild to moderate patients with VPI. Future prospective studies with standardized technique and objective outcomes are required to definitively establish its safety and efficacy, as well as define patient selection criteria.

Applications of Fat Grafting in Pediatric Patients

“…While no consensus exists regarding the best treatment option for velopharyngeal insufficiency, autologous fat grafting has become an increasingly attractive approach to augment the posterior pharyngeal wall to narrow the gap. 49 When treating velopharyngeal insufficiency, autologous fat grafting has been shown to have positive speech outcomes when injected into various regions of the velopharyngeal space, including the soft palate and posterior and lateral pharyngeal walls. 30,49 One study of 46 patients, who underwent autologous fat injection into the soft palate alone, demonstrated improved speech intelligibility and no complications.…”

“…49 When treating velopharyngeal insufficiency, autologous fat grafting has been shown to have positive speech outcomes when injected into various regions of the velopharyngeal space, including the soft palate and posterior and lateral pharyngeal walls. 30,49 One study of 46 patients, who underwent autologous fat injection into the soft palate alone, demonstrated improved speech intelligibility and no complications. The average age in these patients was 5 years, and average length of follow-up was 12 months.…”

“…The average age in these patients was 5 years, and average length of follow-up was 12 months. 49,50 Several case studies have also demonstrated improved speech outcomes after posterior pharyngeal wall augmentation with autologous fat. [51][52][53] Autologous fat grafting with concomitant surgical repair such as z-plasty and sphincterpharyngoplasty can also improve air escape, speech quality, and velar mobility.…”

“…[51][52][53] Autologous fat grafting with concomitant surgical repair such as z-plasty and sphincterpharyngoplasty can also improve air escape, speech quality, and velar mobility. 49,54 Autologous fat grafting for the treatment of velopharyngeal insufficiency has several notable disadvantages. Fat injection into the lateral or posterior pharyngeal wall has resulted in both stroke and patient death from iatrogenic injection into the internal carotid arteries and subsequent fat emboli.…”

“…When performed into the velum alone, it is associated with lower morbidity and fewer complications than traditional surgical treatment options such as pharyngeal flaps, palatoplasty, pharyngoplasty, and synthetic implants. 49 While traditional surgical treatment options may be associated with more risks, they have favorable functional outcomes and are recommended for severe cases of velopharyngeal insufficiency. 6,49 In summary, autologous fat grafting into the velum is a safe, effective, and minimally invasive treatment strategy for select groups of patients with mild velopharyngeal insufficiency.…”