Autologous fat transfer in velopharyngeal insufficiency: Indications and results of a 25 procedures series

ObjectiveTo assess the efficiency of autologous fat transfer (AFT/Coleman procedure) in the management of velopharyngeal insufficiency (VPI).SettingsTertiary academic center, retrospective case series over a 4 year period. Pre- and post-speech assessment by a speech pathologist using the Borel-Maisonny scale.Patients and methodTwenty-five (25) procedures were performed on 22 patients during the considered period. Mean age at surgery was 12.4 ± 4.1 years-old. Main associated conditions were 22q11 deletion (n = 6 including 2 with cleft palate), isolated cleft palate (n = 3), and Robin sequence (n = 2).Indications were VPI grade 2a (n = 5), 2b (n = 11) and 3 (n = 6), despite prolonged speech therapy (pre-op mean duration: 4.2 years) and previous surgery (velopharyngoplasty, n = 13). Four patients had a contraindication of velopharyngoplasty (aberrant internal carotid arteries).Results and conclusionFat harvesting sites were umbilicus (n = 23) and buttock (n = 2). Mean injected fat volume was 7.8 ml, in the posterior wall of the pharynx (n = 25) the soft palate (n = 15), the peritonsillar arches (n = 3), and the pre-existing flap (n = 3). Mean follow-up was 17 months. Two patients relapsed once and one patient twice, requiring additional injections. Final post-operative examination 1 year after the last procedure showed an improvement of speech in 90% of cases (grade 1, n = 2; 1/2a, n = 5; 2a n = 10; 2b, n = 5).AFT is a safe technique indicated in the primary and secondary management of VPI, with stable results on speech. However, if a complete return to normal is difficult to achieve, its simplicity allows multiple procedures in the same patient.