Autologous Fat Graft for the Correction of Minor Velopharyngeal Insufficiency

Objective: Retrospective study on autologous fat injection for minor velopharyngeal insufficiency correction.

Methodology: We report our experience regarding autologous fat injection for the correction of minor velopharyngeal insufficiency. Our indications includes: gaps from short velum, complement of surgical repairing of anatomical velopharyngeal defect after poor speech therapy results. Our series includes eleven patients, seven male and four female ranging in age from 7 to 68 years old (Median: 37.5 years old, mean age of 27 years old). The main symptoms were hypernasality and nasal food regurgitation. Pre-operative evaluation is mainly based on nasendoscopy and subjective scale based speech evaluation performed by the speech therapist’s opinion. All patients underwent fat injection under general anesthesia and 0° and 30° telescope control with a Davis mouth gag. The injection was performed through a 16 G Tuohy needle that secures a Luerlocker syringe. The harvesting site was mainly peri-umbilical. Borele Maisonny scores were used aside with nasendoscopy during the post operative follow up. Also, all patients were contacted by phone for long term subjective appraisal of phonation and speech results.

Results: An average of 11cc of autologous fat was injected (6 to 14cc) for minor velopharyngeal insufficiency correction. Post operative course was uneventful except for one patient who had a retropharyngeal cellulitis that resolved under antibiotics. Minor complains such as otalgia and cervical pain were reported by most of the patients and were managed by paracetamol and non- steroids anti-inflammatory drugs. Long term outcome were estimated satisfactory for most of the patients.

Conclusion: Autologous fat injection is an effective method to correct minor velopharyngeal insuffisancy after poor speech therapy results or as a complement for major velopharyngoplasties.