Parental perceptions of posterior pharyngeal wall augmentation using autologous fat for treating velopharyngeal dysfunction

Autologous Fat Grafting in Velopharyngeal Insufficiency Gives Complete and Stable Speech Recovery in Patient Under 7 years

ABSTRACT

The authorspresent a retrospective observational cohort study of 47 French speaking consecutive patients treated with retropharyngeal wall filling with autologous fat graft from 2006 to 2019 in a single tertiary center, to assess with a long-term follow-up, the best tailored treatment to recovery speech for velopharyngeal insufficiency, and to stress the importance of early treatment with minimally invasive procedure with retropharyngeal wall fat grafting. In preoperative setting, a clinical and instrumental evaluation with aerophonoscope is completed by a palatal closure assessment with nasal endoscopy. All patients were classified according with Borel Maisonny score pre- and post-operatively. Sixty three fat injections were performed. In 4 cases a pharyngeal flap was performed after fat graft for an insufficient speech result. The authors had no complications. Patients with less than 7 years of age obtained a complete recovery of their velopharyngeal incompetence (P = 0.03) compared to older patients. In conclusion, the authors can state that this tailored surgical technique needs a multidisciplinary approach. Many variables can affect postoperative results: fat reabsorption, concurrently performed surgery, pattern of pharyngeal closure, hearing impairment. None of these factors affected our result. Early treatment plays a crucial role to achieve better results. Patients with less of 7 years showed a better result in this functional treatment.

Update on surgery for velopharyngeal dysfunction

PURPOSE OF REVIEW

To review journal articles discussing surgery for velopharyngeal dysfunction over the past year. All articles ascertained by a PubMed search relevant to this topic were reviewed.

RECENT FINDINGS

Articles evaluated from the past year discussed the variations, effectiveness, and feasibility of multiple surgical techniques for velopharyngeal dysfunction, including the Furlow palatoplasty, sphincter pharyngoplasty, pharyngeal flap procedure, and other less known novel surgical options. Outcomes, comparisons, and complications were a focus of the majority of the studies. Combinations of the above procedures are also assessed. Nonsurgical options, such as prosthetic devices and pharyngeal augmentation, are mentioned.

SUMMARY

Multiple surgical options exist to assist patients with velopharyngeal dysfunction. The majority of the surgical options can be highly successful. A multispecialty team is critical in providing patients with the most appropriate treatment for their specific situation. Standardized speech and velopharyngeal dysfunction outcome measures are necessary to allow accurate preoperative and postoperative comparisons, intrasurgeon comparisons, and multi-institutional comparisons. Unfortunately, there is a lack of standardization in speech outcome measures among the studies published over the last year. The risk of postoperative obstructive sleep apnea must be assessed and discussed prior to surgery for any patient scheduled to undergo surgery for velopharyngeal dysfunction. Future studies promise to improve our understanding of velopharyngeal dysfunction and provide further guidance as to the best surgical options to assist these patients.