title: Velopharyngeal insufficiency managed by autologous fat grafting in patients with aberrant courses of internal carotid arteries.
abstract: BACKGROUND
  Velopharyngeal insufficiency (VPI) is usually managed, besides speech therapy, by performing a velopharyngoplasty. An alternative approach is autologous fat grafting (AFG) of the posterior pharyngeal wall. About 5% of the population has internal carotid arteries (ICA) with an aberrant course. This anatomic variation can be responsible for surgical difficulties while when performing a velopharyngoplasty, and therefore lead surgeons to only consider a speech reeducation of VPI. However, AFG is does not bear such surgical morbidity.
  
  
  OBJECTIVE
  The aim of this study is to retrospectively determine AFG efficiency on VPI in patients with aberrant ICA's courses who cannot benefit from a velopharyngoplasty, by comparing pre- and postoperative Borel Maisonny score (BMS) and intelligibility (Intell).
  
  
  METHODS
  We conducted a retrospective study in 2 centers, including children with VPI and aberrant ICA's courses who underwent an AFG of the posterior pharyngeal wall from 2004 to 2015, in addition to speech therapy.
  
  
  RESULTS
  Nine patients (4-11 years old) underwent the surgical procedure, 8 of them presenting a 22q11 microdeletion. All improved their VPI by AFG of the pharyngeal wall according to BMS and Intelligibility after a 10 months follow-up. The effect was stable after 3 years of follow-up. No severe complication (apnea, vascular injury) occured.
  
  
  CONCLUSIONS
  AFG of the pharyngeal wall, associated with speech therapy, seems to be a safe procedure for patients with VIP and aberrant ICA's courses. Multiple procedures are possible if needed.
authors.affiliation: Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France. Electronic address: emiliebois@wanadoo.fr.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bois
authors.affiliation: Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France. Electronic address: charlotte.celerier@aphp.fr.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Celerier
authors.affiliation: Radiology Department, Necker Enfants Malades Hospital, Paris, France. Electronic address: kahina.belhous@aphp.fr.
authors.forename: Kahina
authors.initials: K
authors.lastname: Belhous
authors.affiliation: Speech Therapist, Necker Enfants Malades Hospital, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Maulet
authors.affiliation: Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France. Electronic address: nicolas.leboulanger@aphp.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leboulanger
authors.affiliation: Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France. Electronic address: noel.garabedian@aphp.fr.
authors.forename: Noël
authors.initials: N
authors.lastname: Garabedian
authors.affiliation: Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France. Electronic address: f.denoyelle@aphp.fr.
authors.forename: Françoise
authors.initials: F
authors.lastname: Denoyelle
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D002343:Carotid Artery, Internal / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D010614:Pharynx / Q000601:surgery*; D012189:Retrospective Studies; D013060:Speech; D013064:Speech Disorders / Q000209:etiology; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*
keywords: 22q11 microdeletion; Aberrant internal carotid artery; Autologous fat grafting; Borel-Maisonny score