gms | German Medical Science

Dreiländertagung D-A-CH
24. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie e. V.

Deutsche Gesellschaft für Phoniatrie und Pädaudiologie e. V.

28. - 30.09.2007, Innsbruck, Österreich

Treatment of velopharyngeal insufficiency by autologous fat injection

Poster

  • corresponding author presenting/speaker Igor Leuchter - CHUV, Lausanne, Switzerland
  • Philippe Pasche - CHUV, Lausanne, Switzerland
  • Judith Hohlfeld - CHUV, Lausanne, Switzerland
  • Valérie Schweizer - CHUV, Lausanne, Switzerland

Deutsche Gesellschaft für Phoniatrie und Pädaudiologie. Sektion Phoniatrie der Österreichischen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirugie. Schweizerische Gesellschaft für Phoniatrie. Dreiländertagung D-A-CH, 24. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie e.V.. Innsbruck, Österreich, 28.-30.09.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07dgppP10

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgpp2007/07dgpp29.shtml

Veröffentlicht: 28. August 2007

© 2007 Leuchter et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Abstract

Velopharyngeal insufficiency (VPI) is a structural or a functional trouble which causes an hypernasal speech. Velopharyngeal flaps, speech therapy and augmentation velopharyngoplasty using different implants have all been used to address this trouble. We present our results after autologous fat injection in 9 patients with mild velopharyngeal insufficiency (7 soft palate clefts, 1 functional VPI, 1 myopathy). Fourteen injections were made between 2004 and 2007. The degree of hypernasal speech was evaluated pre- and postoperatively by a speech therapist and an ENT specialist and quantified by an acoustic nasometry (Kay Elemetrics™). All patients were exhaustively treated with speech therapy (average, 8 years). The mean value of the nasalance score was 39% preoperatively and 25% postoperatively (p=0.015). The hypernasality was reduced postoperatively in all patients (1 to 2 degrees of the Borel-Maisonny score). There were no major complications, 2 minor complications (1 hematoma, 1 cervical pain). The autologous fat injection is a safe, minimally invasive procedure and proves to be efficient in cases of mild velopharyngeal insufficiency.


Text

Introduction

Velopharyngeal insufficiency (VPI) is a structural or functional trouble which causes hypernasal speech. Velopharyngeal flaps, speech therapy and augmentation pharyngoplasty have all been used to address this problem. Several kinds of material have been reported as being used as posterior wall implants: vaselin, Teflon, cartilage, autologous fat [1], [2], [3], [4], [5]. We hereby present our results following autologous fat injection in 9 patients with mild velopharyngeal insufficiency between the period of October 2004 and June 2007.

Material and Methods

Our 9 patients (8 female and 1 male) were aged between 10 and 53 years (mean, 20.3 years). The causes of VPI were 7 soft cleft palates, 1 functional VPI and 1 myopathy (Steinert myotonic dystrophy). All of them had slight to moderate hypernasal speech with a Borel-Maisonny score ≤2, a velo-pharyngeal closure ≥50% and a visible velar mobility during nasofibroscopy. Three patients previously had a velopharyngoplasty. All patients were exhaustively treated with speech therapy (average, 8 years) . The degree of hypernasal speech was evaluated pre- and postoperatively by a speech therapist and an ENT specialist and quantified by an acoustic nasometry (Kay Elemetrics™). A nasofibroscopic examination was performed pre- and post-operatively. The procedures were performed under general anaesthesia. The fat was harvested from the periumbilical or medial knee area or by lipoaspiration according to the Coleman technique. The fat was centrifugated for 3 minutes at 3000 rpm and separated from liquid fat and blood. This was then injected transorally under nasofibroscopic visualization, into the submucosa, medially in the rhinopharynx (Figure 1 [Fig. 1]).

Results

Fourteen injections were carried out. The mean value of the nasalance score was 39% preoperatively and 25% postoperatively (p=0.015). The hypernasality was reduced postoperatively in all patients (1 to 2 degrees of the Borel-Maisonny score). There were no major complications, 2 minor complications (1 haematoma, 1 cervical pain).

Conclusion

The autologous fat injection is a simple, safe and minimally invasive procedure. It proves to be efficient in cases of mild velopharyngeal insufficiency or after a suboptimal velopharyngoplasty.


References

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Ward PH, Stoudt R Jr., Goldman R. Improvement of velopharyngeal insufficiency by teflon injection. Trans Am Acad Ophthalmol Otolaryngol. 1967;71(6):923-33.
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Trigos I, Ysunza A, Gonzalez A, Vazquez MC. Surgical treatment of borderline velopharyngeal insufficiency using homologous cartilage implantation with videonasopharyngoscopic monitoring. Cleft Palate J. 1988;25(2):167-70.
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Gaza Wv. Ueber freie Fettgewebstransplantation in den retropharyngealen Raum bei Gaumenspalte. Arch Klin Chir. 1926;142:590-9.
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Dejonckere PH, van Wijngaarden HA. Retropharyngeal autologous fat transplantation for congenital short palate: a nasometric assessment of functional results. The Annals of otology, rhinology, and laryngology. 2001;110(2):168-72.