scholarly journals Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients

2018 ◽  
Vol 51 (02) ◽  
pp. 145-154 ◽  
Author(s):  
Renzo Panizza ◽  
Marco Ghiglione ◽  
Enrico Maria Zingarelli ◽  
Michela Massa ◽  
Claudio Carlini ◽  
...  
Keyword(s):  
Speech Therapy ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Case Series ◽  
Posterior Pharyngeal Wall ◽  
Fat Grafting ◽  
Small Sample ◽  
Wilcoxon Test ◽  
Velopharyngeal Insufficiency ◽  
Pharyngeal Wall

ABSTRACT Introduction: Velopharyngeal insufficiency (VPI) is the inability to close the velopharyngeal sphincter during phonation and/or feeding. VPI is clinically characterised by hypernasal speech and nasal regurgitation. In cases of severe VPI, pharyngoplasty is recommended. Cases of mild-to-moderate VPI can be treated with fat grafting of the posterior pharyngeal wall in addition to speech therapy. The lipofilling can also be useful after pharyngoplasty to improve the outcomes. Materials and Methods: Twenty-one patients (14 males and 7 females), ages 4–23 affected by mild-to-moderate VPI and treated with lipofilling were included in this retrospective study. The mean injected fat volume was 7.95 cc (median 6 cc, min 4 cc, max 20 cc and range 16 cc). The follow-up ranged from 6 to 60 months. The pre- and post-operative Borel–Maisonny scores were compared using Wilcoxon test. Moreover, we performed a telephone survey with the aim to assess the parental perception on child's speech and quality of life after the surgical treatment. Results: Despite the small sample size, in this case series, we observed a statistically significant Borel–Maisonny score improvement and a parental satisfaction rate of about 85%. Conclusions: The augmentation of the posterior pharyngeal wall in addition to speech therapy improved the Borel–Maisonny score and the intelligibility of this case series of patients affected by mild-to-moderate VPI. In these patients, evaluated in a multidisciplinary approach, this technique allowed us to avoid major surgical procedures that would modify the anatomy of the velopharyngeal port. However, prospective comparative studies or randomised controlled trials could be useful to compare fat grafting with velopharyngoplasty techniques, with the aim to clarify indications and to define a specific treatment protocol.

Investigation of the speech results of posterior pharyngeal wall augmentation with fat grafting for treatment of velopharyngeal insufficiency

2017 ◽  
Vol 45 (6) ◽  
pp. 891-896 ◽  
Author(s):  
Çağla Dinsever Eliküçük ◽  
Maviş Emel Kulak Kayıkcı ◽  
Fatma Esen Aydınlı ◽  
Mert Çalış ◽  
Fatma Figen Özgür ◽  
...  
Keyword(s):  
Posterior Pharyngeal Wall ◽  
Fat Grafting ◽  
Velopharyngeal Insufficiency ◽  
Pharyngeal Wall

Management of Speech and Swallowing Disorders in Children with Oral Clefts

2019 ◽  
Author(s):  
Ravi K. Garg ◽  
Delora L Mount
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Treatment Options ◽  
Posterior Pharyngeal Wall ◽  
Diagnostic Tools ◽  
Pharyngeal Wall ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft. This review contains 1 figure, 3 videos, and 58 references.  Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Augmentation of Oral Tissues in Rabbit Using Autogenous Fat

1995 ◽  
Vol 32 (1) ◽  
pp. 1-6 ◽  
Author(s):  
John W. Canady ◽  
Sue Ann Thompson ◽  
Jerald B. Moon ◽  
Richard L. Glowacki
Keyword(s):  
Oral Cavity ◽  
Speech Therapy ◽  
Donor Site ◽  
Posterior Pharyngeal Wall ◽  
Donor Site Morbidity ◽  
Speech Disorders ◽  
Pharyngeal Wall ◽  
Synthetic Materials ◽  
Velopharyngeal Incompetence ◽  
The Stability

Patients with mild velopharyngeal incompetence (VPI) may have speech disorders, which are not sufficiently severe to warrant extensive surgical intervention, yet may not be amenable to correction by speech therapy alone. Augmentation of the posterior pharyngeal wall to aid in closure of the velopharyngeal sphincter may be beneficial in establishing better speech patterns, especially when combined with speech therapy. A variety of materials and techniques have been used in the past for this purpose. In this setting, autogenous fat may be transplanted without the risks incurred by augmentation with synthetic materials and involves very little donor site morbidity. The literature is somewhat contradictory, however, regarding the stability of the augmentation achieved using autogenous fat and there are no histologic studies describing the fate of fat injected into tissues of the oral cavity. Prior to introduction of this technique into clinical practice, this study was designed to investigate the fate of autogenous fat injected submucosally in the oropharyngeal region. Autogenous fat was injected into the anterior soft palate using the rabbit as a model. Histologic and gross inspections were performed at 2 days, 1, 2, and 4 weeks after injections. At the end of 4 weeks, at least 50% of the injection sites had visible evidence of augmentation, and 90% had histologic evidence of submucosal fat. In some instances most of the fat was resorbed; however, there were no instances of clinical infection or necrosis of the injection site. We conclude that submucosal injection of autogenous fat is a feasible alternative to using synthetic or other biologic materials for augmentation in the oral cavity.

scholarly journals Ayurveda Treatment Protocol in the Management of Galagraha (Pharyngitis)- A Case Study

2020 ◽  
Vol 6 (2) ◽  
pp. 63-65
Author(s):  
NV Vidya ◽  
◽  
EP Bineesh ◽  
Dr. DB Vaghela ◽  
◽  
...  
Keyword(s):  
Treatment Protocol ◽  
Posterior Pharyngeal Wall ◽  
Signs And Symptoms ◽  
Paediatric Population ◽  
Pharyngeal Wall ◽  
Doctor Visit ◽  
Body Sensation ◽  
Ayurvedic Treatment ◽  
Marked Relief

Pharyngitis is inflammation of the pharynx, which affects in back of the throat. It is most often referred to simply as sore throat; it is one of the most common reasons for doctor visit. The condition is the usual phenomenon in paediatric population due to intake of cold drinks, junk food etc. This disease is more recurrent now a days than earlier As per ayurvedic classics the condition has close similarity with the disease Galagraha. Aim: In this article management of pharyngitis with ayurvedic modalities were discussed. Material & Method: A 32 years male patient visited ENT OPD of Shalakya Tantra, I.P.G.T&R.A Hospital on 16/12/2019 with complaints of pain and foreign body sensation of throat, Recurrent moderate cough, mild fever and head ache, difficulty in swallowing along with congestion in posterior pharyngeal wall aggravate since 10 days. He consulted a local hospital near his house but didn’t get a satisfactory relief. History reveals the reccurents of disease since 3 years. We started Triphala + Darvi kwatha kawala thrice/Day, Haritaki Kwatha pana Twice BD with honey (20 ml Before food), Khadiradi vati (2 Tab -4 times/ day) for Chushanartha, Sitopaladi churna -3gm +Yastimadhu 1 gm, Naradiya Lakshmi vilasa rasa-125 mg-2 times a day for 14 days Followed by Virechana and Nasya. Marked relief was found in signs and symptoms within 7 days and cured completly within 21 days of treatment. Conclusion: Study concluded that the above Ayurvedic treatment can prove to be an effective alternate management in Chronic Catarrhal Pharyngitis with proper diet and regimen.

Safety and Efficacy Concerns of Autologous Fat Grafting for Velopharyngeal Insufficiency

2017 ◽  
Vol 55 (3) ◽  
pp. 383-388 ◽  
Author(s):  
Yun S. Phua ◽  
Mark J. Edmondson ◽  
Rachel J. Kerr ◽  
Kirstie A. Macgill ◽  
Rodrigo P. Teixeira ◽  
...  
Keyword(s):  
Revisional Surgery ◽  
Case Series ◽  
Fat Grafting ◽  
Velopharyngeal Insufficiency ◽  
Autologous Fat Grafting ◽  
Retrospective Case ◽  
Safety And Efficacy ◽  
Autologous Fat ◽  
Obstructive Sleep ◽  
Speech Assessment

Objective: Autologous fat grafting of the velopharynx has been well described for the treatment of velopharyngeal insufficiency (VPI), with most studies purporting it as a technique with low morbidity useful in the treatment of mild VPI. Prompted by 3 cases of obstructive sleep apnea (OSA) following fat grafting of the velopharynx, we undertook a review of the outcomes of this procedure at our unit. Design: Retrospective case series. Participants: All patients who underwent autologous fat grafting for VPI at the Royal Children’s Hospital Melbourne. Main Outcome Measures: Preoperative nasendoscopy findings, perceptual speech assessment results, and rates of revisional surgery and complications. Results: Twenty-eight patients were included in the study. Three patients (11%) developed severe OSA requiring removal of the grafted fat. In a subanalysis of cleft patients, there was a reported improvement in hypernasality in 63% though only 25% had complete resolution of their hypernasality. Patients who had an improvement in speech were more likely to have a velopharyngeal gap of less than 0.5 cm2 on preoperative nasendoscopy. All 3 patients who developed OSA had syndromes associated with hypotonia. Conclusions: This study raises serious concerns over the safety and efficacy of fat grafting for VPI. Overall, there was a relatively high complication rate with generally poor speech results in our series of patients. Stringent criteria should be used to select candidates for fat grafting, namely, a velopharyngeal gap less than 0.5 cm2 and the absence of a syndrome associated with hypotonia.

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