Autologous fat transfer in velopharyngeal insufficiency: Indications and results of a 25 procedures series

• Published in: International journal of pediatric otorhinolaryngology Vol. 75; no. 11; pp. 1404 - 1407
• Main Authors: Nicolas, Leboulanger, Marion, Blanchard, Françoise, Denoyelle, Fergal, Glynn, Jean-Baptiste, Charrier, Gilles, Roger, Jean-Paul, Monteil, Eréa-Noël, Garabedian
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.11.2011
• Subjects: Adipose Tissue - transplantation; Adolescent; Autologous fat transfer; Child; Children; Cohort Studies; Coleman; Female; Follow-Up Studies; Humans; Male; Otolaryngology; Pediatrics; Recovery of Function; Retrospective Studies; Risk Assessment; Severity of Illness Index; Time Factors; Transplantation, Autologous; Treatment Outcome; Velopharyngeal insufficiency; Velopharyngeal Insufficiency - diagnosis; Velopharyngeal Insufficiency - surgery; Autologous fat transfer; Coleman; Children; Velopharyngeal insufficiency
• DOI: 10.1016/j.ijporl.2011.08.001
• ISSN: 0165-5876

Abstract Objective To assess the efficiency of autologous fat transfer (AFT/Coleman procedure) in the management of velopharyngeal insufficiency (VPI). Settings Tertiary academic center, retrospective case series over a 4 year period. Pre- and post-speech assessment by a speech pathologist using the Borel-Maisonny scale. Patients and method Twenty-five (25) procedures were performed on 22 patients during the considered period. Mean age at surgery was 12.4 ± 4.1 years-old. Main associated conditions were 22q11 deletion ( n = 6 including 2 with cleft palate), isolated cleft palate ( n = 3), and Robin sequence ( n = 2). Indications were VPI grade 2a ( n = 5), 2b ( n = 11) and 3 ( n = 6), despite prolonged speech therapy (pre-op mean duration: 4.2 years) and previous surgery (velopharyngoplasty, n = 13). Four patients had a contraindication of velopharyngoplasty (aberrant internal carotid arteries). Results and conclusion Fat harvesting sites were umbilicus ( n = 23) and buttock ( n = 2). Mean injected fat volume was 7.8 ml, in the posterior wall of the pharynx ( n = 25) the soft palate ( n = 15), the peritonsillar arches ( n = 3), and the pre-existing flap ( n = 3). Mean follow-up was 17 months. Two patients relapsed once and one patient twice, requiring additional injections. Final post-operative examination 1 year after the last procedure showed an improvement of speech in 90% of cases (grade 1, n = 2; 1/2a, n = 5; 2a n = 10; 2b, n = 5). AFT is a safe technique indicated in the primary and secondary management of VPI, with stable results on speech. However, if a complete return to normal is difficult to achieve, its simplicity allows multiple procedures in the same patient.