Posterior Pharyngeal Fat Grafting for Velopharyngeal Insufficiency

作者：Lau Darryl; Oppenheimer Adam J^*; Buchman Steve R; Berger Mary; Kasten Steven J

来源：Cleft Palate-Craniofacial Journal, 2013, 50(1): 51-58.

DOI：10.1597/11-038

• cleft palate
• fat grafting
• velopharyngeal insufficiency

Objective: To determine if autologous fat grafting to the posterior pharynx can reduce hypernasality in patients with cleft palate and mild velopharyngeal insufficiency (VPI).
Design: Retrospective case series.
Setting: Tertiary care center.
Patients: Eleven patients with cleft palate status after palatoplasty (with or without secondary speech surgery) with nasendoscopic evidence of VPI.
Interventions: Autologous fat was harvested and injected into the posterior pharynx under general anesthesia.
Main Outcome Measures: Pre- and postoperative subjective, nasometry, and nasendoscopy data. Apnea-hypopnea indices (AHIs) were also assessed. Comparisons were made using Fisher's exact test, Student's t tests, and relative risk (RR) assessments.
Results: An average of 13.1 mL of fat was injected (range: 5 to 22 mL). Mean follow-up was 17.5 months (range: 12 to 25 months). Statistically significant improvements in speech resonance were identified in nasometry (Zoo passage; p = .027) and subjective hypernasality assessment (p = .035). Eight of the patients (73%) demonstrated normal speech resonance after posterior pharyngeal fat grafting (PPFG) on subjective or objective assessment (p = .001). All five patients with previous secondary speech surgeries demonstrated normal speech resonance on similar assessment (RR = 1.8; p = .13). Complete velopharyngeal closure was observed in seven patients on postoperative nasendoscopy. No changes in AHIs were observed (p = .581).
Conclusion: PPFG may be best used as an adjunct to secondary speech surgery. In this series, PPFG was not accompanied by the negative sequelae of hyponasality, sleep apnea, or airway compromise.

• 出版日期2013-1