title: Speech and magnetic resonance imaging results following autologous fat transplantation to the velopharynx in patients with velopharyngeal insufficiency.
abstract: OBJECTIVE
  To measure velopharyngeal closure with magnetic resonance imaging (MRI) and to evaluate speech when treating velopharyngeal insufficiency (VPI) with autologous fat transplantation to the velopharynx.
  
  
  METHODS
  Nine patients were recruited. Six patients had undergone cleft palate repair and subsequently developed VPI. Three were noncleft patients of which one had developed VPI after nasopharyngeal cancer treatment; another patient had developed VPI after combined adenotonsillectomy, and a third patient had VPI of unknown etiology.
  
  
  METHODS
  Preoperative and 1-year postoperative MRIs were obtained during vocal rest and during phonation. Data measured were the velopharyngeal distance in the sagittal plane and the velopharyngeal gap area in the axial plane. Preoperative and 1-year postoperative audio recordings were blinded for scoring independently by three senior speech therapists.
  
  
  RESULTS
  When comparing preoperative and 1-year postoperative MRI during phonation we found a significant reduction of the median velopharyngeal distance from 4 to 0 mm (p = .011), and a significant reduction of the median velopharyngeal gap area from 42 to 34 mm(2) (p = .038). Nasal turbulence improved significantly (p = .011). Hypernasality/hyponasality and audible nasal emission did not change significantly.
  
  
  CONCLUSIONS
  Autologous fat transplantation to the velopharynx resulted in a significant reduction of the velopharyngeal distance and the velopharyngeal gap area during phonation, as measured by MRI. This was in accordance with a significant improvement in nasal turbulence. However, hypernasality and audible nasal emission did not change significantly and could not be correlated to the MRI findings.
authors.forename: Charles
authors.initials: C
authors.lastname: Filip
authors.forename: Michael
authors.initials: M
authors.lastname: Matzen
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Aagenæs
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Aukner
authors.forename: Lillian
authors.initials: L
authors.lastname: Kjøll
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Høgevold
authors.forename: Frank
authors.initials: F
authors.lastname: Abyholm
authors.forename: Kim
authors.initials: K
authors.lastname: Tønseth
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010699:Phonation / Q000502:physiology; D011446:Prospective Studies; D013068:Speech Production Measurement / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000503:physiopathology* / Q000601:surgery*