Speech Outcome Following Autologous Fat Grafting in Soft Palate for Velopharyngeal Insufficiency

Abstract

Objective

Autologous fat graft injection to the soft palate is a relatively new treatment for velopharyngeal insufficiency (VPI). This study aimed at evaluating the outcome following fat injection into soft palate and speech therapy in selected patients to determine the good candidates.

Design

Retrospective case series.

Setting

Institutional tertiary hospital.

Patients

The study included 22 patients with VPI associated with repaired cleft palate (CP), submucous cleft, or post-adenoidectomy. The inclusion criteria were mild to moderate hypernasality and velopharyngeal closure > 50%. Patients with severe hypernasality, intelligibility grade 4, closure < 50%, syndromic CP, intellectual disability, and hearing impairment were excluded.

Interventions

Autologous fat was injected into the velum trans-orally under endoscopic guidance followed by speech therapy. Motor-phonetic and biofeedback therapies were carried out 3 sessions weekly for 3 months to treat misarticulations and residual hypernasality. Speech scores were assessed preoperative and post-therapy.

Main Outcome Measures

Scores of hypernasality, nasal emission, speech intelligibility, and velopharyngeal closure.

Results

The hypernasality, nasal emission, speech intelligibility, and VP closure scores significantly improved following fat injection and speech therapy (P < .001, .008, .004, and .015 respectively). The predictive factors of better outcome were young age, post-adenoidectomy, small gap, transverse palatal muscles, and coronal closure (P < .02, .005, .004, .001, and .002 respectively).

Conclusions

Fat injection into the soft palate followed by speech therapy is a safe and successful treatment for mild to moderate VPI and best selected for patients with transverse palatal muscles, young children, and small gaps. Further studies with a greater number of subjects are needed.