Rhinopharyngeal autologous fat injection for treatment of velopharyngeal insufficiency in patients with cleft palate

Piotet, Elsa; Beguin, Céline; Broome, Martin; Iglesias, Katia; Olivier, F; Leuchter, Igor; Zbinden, Chantal; Hohlfeld, Judith; Roessingh, Anthony de Buys; Schweizer, Valérie; Pelletier, Philippe

doi:10.1007/s00405-014-3380-0

Cited by 30 publications

(35 citation statements)

References 30 publications

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

“…[ 22 ] Lipofilling for the treatment of VPI has been proposed since 2001 and at our knowledge in the literature are present 13 published articles. [ 1 10 23 24 25 ] All the cited studies reported good results, and despite the potential major risks (obstructive sleep apnoea, fat embolism and/or injuries to the internal carotid artery), many authors insist on the safety of the procedure and on the possibility of its repetition in case of partial improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Velopharyngeal insufficiency (VPI) is the inability to close the velopharyngeal sphincter during phonation and/or feeding that can be a consequence of an enlarged velopharyngeal gap and a diminished muscular contraction of the velum and posterolateral pharyngeal walls. [ 1 ] The causes of VPI can be either congenital or iatrogenic. Moreover, VPI can be linked to over 400 recognised syndromes[ 2 ] and a correct pre-operative diagnosis is mandatory in terms of a proper clinical orientation.…”

Section: Introductionmentioning

confidence: 99%

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

Panizza

Ghiglione

Zingarelli

et al. 2018

Indian J Plast Surg

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Introduction:Velopharyngeal insufficiency (VPI) is the inability to close the velopharyngeal sphincter during phonation and/or feeding. VPI is clinically characterised by hypernasal speech and nasal regurgitation. In cases of severe VPI, pharyngoplasty is recommended. Cases of mild-to-moderate VPI can be treated with fat grafting of the posterior pharyngeal wall in addition to speech therapy. The lipofilling can also be useful after pharyngoplasty to improve the outcomes.Materials and Methods:Twenty-one patients (14 males and 7 females), ages 4–23 affected by mild-to-moderate VPI and treated with lipofilling were included in this retrospective study. The mean injected fat volume was 7.95 cc (median 6 cc, min 4 cc, max 20 cc and range 16 cc). The follow-up ranged from 6 to 60 months. The pre- and post-operative Borel–Maisonny scores were compared using Wilcoxon test. Moreover, we performed a telephone survey with the aim to assess the parental perception on child's speech and quality of life after the surgical treatment.Results:Despite the small sample size, in this case series, we observed a statistically significant Borel–Maisonny score improvement and a parental satisfaction rate of about 85%.Conclusions:The augmentation of the posterior pharyngeal wall in addition to speech therapy improved the Borel–Maisonny score and the intelligibility of this case series of patients affected by mild-to-moderate VPI. In these patients, evaluated in a multidisciplinary approach, this technique allowed us to avoid major surgical procedures that would modify the anatomy of the velopharyngeal port. However, prospective comparative studies or randomised controlled trials could be useful to compare fat grafting with velopharyngoplasty techniques, with the aim to clarify indications and to define a specific treatment protocol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Panizza

Ghiglione

Zingarelli

et al. 2018

Indian J Plast Surg

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“…Piotet et al [11] reported their series of fat augmentation in 22 patients with either cleft lip or palate. Their group noted a favorable rate of short-term improvement in nasalance (88%), but less than half of these patients (n = 8) had undergone prior pharyngoplasty.…”

Section: Discussionmentioning

confidence: 99%

Calcium Hydroxylapatite Injection for Persistent Velopharyngeal Insufficiency after Sphincter Pharyngoplasty

O’Connell¹,

Ak²,

Gudis³

et al. 2015

ORL

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Background: The role of calcium hydroxylapatite injection pharyngoplasty after failed sphincter pharyngoplasty surgery has not previously been described. We report our technique of injecting calcium hydroxylapatite into the pharyngoplasty site to add bulk to specific areas of the velopharyngeal port. Methods: A retrospective review of children undergoing calcium hydroxylapatite injection pharyngoplasty for persistent velopharyngeal insufficiency after sphincter pharyngoplasty was performed. Our surgical technique is described. Outcome measures included postoperative perceptual assessment of resonance, improvement in phoneme-specific nasometry scores, and rate of revision surgery. Results: Fourteen patients were included in the study. Improvement in hypernasality on perceptual assessment was noted in the majority of children (85.7%). The rate of achievement of normal resonance on perceptual analysis was 35.7%. A significant decrease in nasometry scores was noted for the following phonemes: /pa/, /sa/, /sha/, and /pi/. There were no intraoperative complications or immediate postoperative complications associated with calcium hydroxylapatite injection. Conclusions: Our early experience suggests that calcium hydroxylapatite injection after failed sphincter pharyngoplasty is a safe, minimally invasive technique with favorable short-term results.

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“…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. 49,54 Autologous fat grafting for the treatment of velopharyngeal insufficiency has several notable disadvantages.…”

Section: Velopharyngeal Insufficiency and Cleft Palatementioning

confidence: 99%

Applications of Fat Grafting in Pediatric Patients

Shih

Abu‐Ghname

Davis

et al. 2020

Seminars in Plastic Surgery

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Autologous fat grafting has become a widely utilized technique for a variety of cosmetic and reconstructive procedures. Its potential for volume restoration and tissue regeneration has made it a popular method for treating soft tissue defects in both adult and pediatric populations. While autologous fat grafting in the pediatric setting is not as well characterized as it is in the adult setting, various reports have demonstrated the safety and utility of its applications in nonadult patient populations. In this article, we present the first comprehensive review of the current applications of autologous fat grafting in pediatric patients. Specific challenges to fat grafting in the pediatric setting and future applications will also be discussed.

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Rhinopharyngeal autologous fat injection for treatment of velopharyngeal insufficiency in patients with cleft palate

Cited by 30 publications

References 30 publications

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

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

Calcium Hydroxylapatite Injection for Persistent Velopharyngeal Insufficiency after Sphincter Pharyngoplasty

Applications of Fat Grafting in Pediatric Patients

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