Posterior Pharyngeal Fat Grafting for Velopharyngeal Insufficiency

Objective To determine if autologous fat grafting to the posterior pharynx can reduce hypernasality in patients with cleft palate and mild velopharyngeal insufficiency (VPI). Design Retrospective case series. Setting Tertiary care center. Patients Eleven patients with cleft palate status after palatoplasty (with or without secondary speech surgery) with nasendoscopic evidence of VPI. Interventions Autologous fat was harvested and injected into the posterior pharynx under general anesthesia. Main Outcome Measures Pre- and postoperative subjective, nasometry, and nasendoscopy data. Apnea-hypopnea indices (AHIs) were also assessed. Comparisons were made using Fisher's exact test, Student's t tests, and relative risk (RR) assessments. Results An average of 13.1 mL of fat was injected (range: 5 to 22 mL). Mean follow-up was 17.5 months (range: 12 to 25 months). Statistically significant improvements in speech resonance were identified in nasometry (Zoo passage; p = .027) and subjective hypernasality assessment (p= .035). Eight of the patients (73%) demonstrated normal speech resonance after posterior pharyngeal fat grafting (PPFG) on subjective or objective assessment (p = .001). All five patients with previous secondary speech surgeries demonstrated normal speech resonance on similar assessment (RR = 1.8; p = .13). Complete velopharyngeal closure was observed in seven patients on postoperative nasendoscopy. No changes in AHIs were observed (p=.581). Conclusion PPFG may be best used as an adjunct to secondary speech surgery. In this series, PPFG was not accompanied by the negative sequelae of hyponasality, sleep apnea, or airway compromise.