Autologous fat transplantation to the velopharynx for treating mild velopharyngeal insufficiency: a 10-year experience

Abstract Background For the last two decades, autologous fat transplantation has been used to treat mild velopharyngeal insufficiency (VPI); however, there is still disagreement about its effectiveness. The aim of the study was to evaluate the procedure by using speech analysis and magnetic resonance imaging (MRI). Patients and Methods A prospective study of 47 non-syndromic patients with mild VPI who underwent autologous fat transplantation to the velopharynx between 2006 and 2015. Thirty-two patients had a cleft palate, all of which had been repaired prior to fat transplantation. Eight patients developed VPI after adenotonsillectomy, one after uvulo-palatoplasty and six had VPI of unknown aetiology. Twelve patients underwent two procedures of fat transplantation. Pre- and 1-year postoperative audio recordings were blinded for scoring independently by three senior speech therapists on a five-point scale. Pre- and 1-year postoperative MRIs were obtained during phonation, measuring the velopharyngeal distance and the velopharyngeal gap area. Correlations between the speech outcomes and MRI were calculated. Results Audible nasal emission was the only speech parameter that improved significantly postoperatively ( p =0.005). A significant reduction of both velopharyngeal distance ( p p p =0.03).There was no significant correlation between speech outcomes and MRI. Conclusions Autologous fat transplantation for the treatment of mild VPI, whilst significantly reducing audible nasal emission, made no significant improvement in hypernasality or nasal turbulence. No complications were observed.