Retropharyngeal Autologous Fat Transplantation for Congenital Short Palate: A Nasometric Assessment of Functional Results

Seventeen patients (4 to 24 years old; mean, 9.7 years) with mild velopharyngeal insufficiency were treated in our department during the period 1996 to 1999 with augmentation of the posterior pharyngeal wall with autologous fat. The main disorder was a congenital short palate without a cleft, in most cases revealed by adenoidectomy. Four patients had previously undergone pharyngoplasty, and I had already been injected in the posterior pharyngeal wall with Teflon paste. All patients had been exhaustively treated with speech therapy, and the result remained unsatisfactory. The functional outcome of the surgical procedure was quantified by acoustic nasometry. The decrease of the nasalance percentage for a standardized spoken passage was significant I to 3 months after the fat transplantation, and there was a slight tendency to further reduction of nasality at the late follow-up visit, more than 6 months (average, 9.4 months) after the intervention. The mean value of the nasalance score for the “normal passage” (running speech) then reached the limit of normal values. A long-term follow-up (average, 24.3 months) by telephone questionnaire confirmed the persistence of the beneficial results. Autologous fat seems an excellent alternative for Teflon in this indication. Acoustic nasometry allows a precise quantitative assessment of functional velopharyngeal surgery.