Autologous Fat Injection Pharyngoplasty in Adults with Velopharyngeal Insufficiency.

Abstract

Understand the utility and technique of injection pharyngoplasty with autologous fat for the treatment of mild to moderate velopharyngeal insufficiency in adults without a history of cleft palate. Consecutive case series of 11 patients (mean [SD] 41 ± 21 years of age) who underwent injection pharyngoplasty with autologous fat from 2012 to 2018 at a tertiary care center. Patients were followed for a mean of 8.6 ± 8 months with pre versus postoperative evaluations of improvement in rhinophonia, dysphagia, and velopharyngeal closure by nasopharyngoscopy (scored: 0, none; 1, mild; 2, moderate; 3, near-complete; 4, complete). Patient selection and surgical techniques are described. Mean improvements were 2.3 ± 0.86 for rhinophonia, 2.0 ± 0.89 for dysphagia, and 3.0 ± 0.95 for velopharyngeal closure by nasopharyngoscopy. Five (45%) patients underwent subsequent intervention, including four repeat fat injections and three sphincter pharyngoplasties. There were two transient complications-donor site hematoma and subjective nasal obstruction. Although objective assessments are lacking to date, this is among the first reports to demonstrate the effectiveness and safety of injection pharyngoplasty with autologous fat for velopharyngeal insufficiency in a population of adults without a history of cleft. We found, on average, moderate improvement in rhinophonia and dysphagia, and near-complete improvement in velopharyngeal closure by nasopharyngoscopy; however, a portion of patients required subsequent intervention.