title: Autologous fat transfer in velopharyngeal insufficiency: indications and results of a 25 procedures series.
abstract: OBJECTIVE
  To assess the efficiency of autologous fat transfer (AFT/Coleman procedure) in the management of velopharyngeal insufficiency (VPI).
  
  
  METHODS
  Tertiary academic center, retrospective case series over a 4 year period. Pre- and post-speech assessment by a speech pathologist using the Borel-Maisonny scale.
  
  
  METHODS
  Twenty-five (25) procedures were performed on 22 patients during the considered period. Mean age at surgery was 12.4 ± 4.1 years-old. Main associated conditions were 22q11 deletion (n=6 including 2 with cleft palate), isolated cleft palate (n=3), and Robin sequence (n=2). Indications were VPI grade 2a (n=5), 2b (n=11) and 3 (n=6), despite prolonged speech therapy (pre-op mean duration: 4.2 years) and previous surgery (velopharyngoplasty, n=13). Four patients had a contraindication of velopharyngoplasty (aberrant internal carotid arteries).
  
  
  CONCLUSIONS
  Fat harvesting sites were umbilicus (n=23) and buttock (n=2). Mean injected fat volume was 7.8 ml, in the posterior wall of the pharynx (n=25) the soft palate (n=15), the peritonsillar arches (n=3), and the pre-existing flap (n=3). Mean follow-up was 17 months. Two patients relapsed once and one patient twice, requiring additional injections. Final post-operative examination 1 year after the last procedure showed an improvement of speech in 90% of cases (grade 1, n=2; 1/2a, n=5; 2a n=10; 2b, n=5). AFT is a safe technique indicated in the primary and secondary management of VPI, with stable results on speech. However, if a complete return to normal is difficult to achieve, its simplicity allows multiple procedures in the same patient.
authors.affiliation: Otolaryngology, Head and Neck Surgery Department, Armand-Trousseau Children Hospital, Paris, France. nicolas.leboulanger@trs.aphp.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leboulanger
authors.forename: Leboulanger
authors.initials: L
authors.lastname: Nicolas
authors.forename: Marion
authors.initials: M
authors.lastname: Blanchard
authors.forename: Blanchard
authors.initials: B
authors.lastname: Marion
authors.forename: Françoise
authors.initials: F
authors.lastname: Denoyelle
authors.forename: Denoyelle
authors.initials: D
authors.lastname: Françoise
authors.forename: Fergal
authors.initials: F
authors.lastname: Glynn
authors.forename: Glynn
authors.initials: G
authors.lastname: Fergal
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Charrier
authors.forename: Charrier
authors.initials: C
authors.lastname: Jean-Baptiste
authors.forename: Gilles
authors.initials: G
authors.lastname: Roger
authors.forename: Roger
authors.initials: R
authors.lastname: Gilles
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Monteil
authors.forename: Monteil
authors.initials: M
authors.lastname: Jean-Paul
authors.forename: Eréa-Noël
authors.initials: EN
authors.lastname: Garabedian
authors.forename: Garabedian
authors.initials: G
authors.lastname: Eréa-Noël
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis* / Q000601:surgery*