title: Autologous fat transplantation to the velopharynx for treating persistent velopharyngeal insufficiency of mild degree secondary to overt or submucous cleft palate.
abstract: BACKGROUND
  Autologous fat transplantation to the velopharynx has been described in a few smaller studies including heterogeneous groups of patients for the treatment of velopharyngeal insufficiency (VPI). The aim of this study was to evaluate speech and to measure velopharyngeal closure with magnetic resonance imaging (MRI) in patients who underwent autologous fat transplantation for the treatment of persistent VPI of mild degree secondary to overt or submucous cleft palate.
  
  
  METHODS
  A prospective study of 16 patients with persistent VPI of mild degree secondary to overt or submucous cleft palate who underwent autologous fat transplantation to the velopharynx. The patients were injected with a median of 5.6 (3.8-7.6) ml autologous fat to the velopharynx. Pre- and 1-year postoperative audio recordings were blinded for scoring independently by three senior speech therapists. Hypernasality, hyponasality, nasal turbulence and audible nasal emission were scored on a five-point scale. Pre- and 1-year postoperative MRIs were obtained during vocal rest and during phonation in 12 patients. Data measured were the velopharyngeal distance in the sagittal plane and the velopharyngeal gap area in the axial plane.
  
  
  RESULTS
  Hypernasality improved significantly (p=0.030), but not audible nasal emission (p=0.072) or nasal turbulence (p=0.12). The velopharyngeal distance during phonation decreased significantly (p=0.013), but not the velopharyngeal gap area (p=0.16). There was no significant correlation between speech and MRI results.
  
  
  CONCLUSIONS
  Autologous fat transplantation to the velopharynx improved hypernasality significantly, but not audible nasal emission or nasal turbulence in patients with persistent VPI of mild degree secondary to overt or submucous cleft palate. Given the low number of patients and the lack of a control group, the value of fat transplantation for the treatment of mild VPI is not proven for sure.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, PO Box 4950, Nydalen, 0424 Oslo, Norway. cfilip@ous-hf.no
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: Kim
authors.initials: K
authors.lastname: Tønseth
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009664:Norway; D015588:Observer Variation; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D013065:Speech Intelligibility; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality; D055815:Young Adult