Autologous Fat Injection Combined with Palatoplasty and Pharyngoplasty for Velopharyngeal Insufficiency and Cleft Palate

Abstract

Objective The aim was to evaluate clinical application of autologous fat transplantation in the posterior pharynx to treat velopharyngeal incompetence and cleft palate. Study Design Case series with chart review. Setting Cleft Lip and Palate Center of Plastic Surgery Hospital, an academic medical center. Subjects and Methods We studied 11 patients (age, 5-26 years) with a cleft palate and velopharyngeal insufficiency who underwent autologous fat injection. Patients were followed for 9 to 40 months. Pronunciation evaluation, visual appearance of the palatopharyngeal area, nasopharyngeal fibroscopy (NPF), palatopharyngeal lateral radiography, and magnetic resonance imaging (MRI) were undertaken before and after the operation. Results Speech intelligibility was markedly increased in all patients. Pronunciation was good to excellent compared with the preoperative level ( P = .001). Mean velopharyngeal insufficiency rate was significantly reduced from 26.05% to 6.96% ( P = .028) by NPF and from 26.42% to 7.11% ( P = .017) by MRI (axial plane). Magnetic resonance imaging indicated significantly reduced mean minimum velopharyngeal distance, from 10.39 to 3.65 mm ( P = .012) in the sagittal plane, and markedly increased thickness of transplanted fat in the posterior pharyngeal wall (sagittal, 5.43 mm; axial, 4.74 mm). There were few complications (sleep apnea, nasopharyngeal regurgitation). Conclusion Autologous fat transplantation in the posterior pharyngeal wall was a good method for treating velopharyngeal incompetence. The safety profile was good in our sample, and we got a consistent result in the follow-up period. In addition, it also could be combined with routine surgery.