Regenerative Approach to Velopharyngeal Incompetence with Fat Grafting

Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients

“…The goals of the augmentation of the posterior wall of the pharynx with the lipofilling are to improve voice resonance and correct nasal air escape by reducing the velopharyngeal gap. As reported in the literature,[ 1 2 3 4 5 6 7 8 ] the lipofilling allows to create a neo-Passavant's pad improving the intelligibility of the speech in cases of mild-to-moderate VPI. This technique has been reported to have good results since the first published works of Dejonckere in 2001[ 9 ] and Bardot et al .…”

“…The injection technique is of paramount importance and should be performed very carefully with the aim to limit the risk of complications such as embolism[ 7 36 ] and obstructive sleep apnoea. [ 37 ] The patient should be placed supine and the ventilation tube should pass through the mouth.…”

“…The assistance of an endoscope can be useful to better visualise the operating field. [ 7 ] It is also essential to pull the plunger back of the syringe before fat injection, in order to avoid fat embolism.…”

“…clarified the level of the fat placement into the submucosal plane of the posterior pharyngeal wall performing two stab incisions respecting the midline. [ 7 ] Since 2012, when we started to treat VPI with lipofilling we have been injecting the fat only into the posterior pharyngeal wall (in multiple tunnels in the midline and paramedian), performing one incision in the midline with the aim to reduce the risk of major complications such as obstructive sleep apnoea and embolism as highlighted by Bishop et al . [ 25 ] in their review.…”

“…[ 37 ] The role of lipofilling in the VPI treatment is to reduce the velopharyngeal gap (a small amount of fat is generally required) and to soften scar contractures after cleft palate repair, facilitating the approximation of the velum to the posterior pharyngeal wall. [ 7 ] Recent studies have confirmed the important role of the stromal vascular fraction of the injected fat in the angiogenesis and regeneration for fibrotic scar treatment. [ 39 ]…”