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

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: This is 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 before fat transplantation. Eight patients developed VPI after adenotonsillectomy, one after uvulo-palatoplasty and six had VPI of unknown etiology. Twelve patients underwent two procedures of fat transplantation. Preoperative and 1-year postoperative audio recordings were blinded for scoring independently by three senior speech therapists on a five-point scale. Preoperative 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 in both velopharyngeal distance (p < 0.005) and the gap area (p < 0.005) was found after treatment. A significant improvement in the mobility of the velum was observed after treatment (p = 0.03). There was no significant correlation between speech outcomes and MRI. CONCLUSIONS: Autologous fat transplantation for the treatment of mild VPI, although significantly reducing audible nasal emission, made no significant improvement in hypernasality or nasal turbulence. No complications were observed.