The aim of this article was to describe the technical details of a fat injection procedure for the treatment of mild to moderate velopharyngeal insufficiency (VPI). Before surgery, the velopharyngeal gap is assessed by means of flexible nasoendoscopy, and speech intelligibility, hypernasality, and nasal air escape are perceptually evaluated and scored by independent raters; nasal airflow during speech is objectively measured. The lipoaspirate is centrifuged at 1200g for 3 minutes to separate and remove blood, cell debris, and the oily layer. Patients are injected with 3.5 to 8 mL of fat in the posterior and lateral pharyngeal walls and soft palate under general anesthesia. The fat is placed within the superior constrictor muscle on the posterior pharyngeal wall to avoid injection behind the prevertebral fascia and possible intraoperative or postoperative fat displacement in a caudal direction. A 19-gauge malleable, blunt, single-hole cannula is used for fat grafting, and the operative field is exposed by means of a Digman mouth gag. Two Nelaton probes are inserted through the nostrils and retracted from the mouth under moderate tension to favor visualization of the nasopharynx. No donor-site or injection-site morbidity has been observed so far, and the 12 patients (aged 5-48 y) treated so far have not manifested snoring or nasal obstruction at any time after surgery. Improved voice resonance is audible soon after the operation, and no hyponasality can be detected. The patients are discharged the day after surgery. Subsequent fat grafting procedures can be performed to achieve further improvement.Correctly performed fat injections improve voice resonance and reduce nasal air escape in VPI, as demonstrated by nasoendoscopy, speech perceptual evaluation, and the objective measurement of nasal airflow and represent an alternative to velopharyngoplasty for mild to moderate VPI.
Fat injections for the treatment of velopharyngeal insufficiency / G. Cantarella, R.F. Mazzola, M. Mantovani, I.C. Mazzola, G. Baracca, L. Pignataro. - In: THE JOURNAL OF CRANIOFACIAL SURGERY. - ISSN 1049-2275. - 23:3(2012 May), pp. 634-637. ((Intervento presentato al 14. convegno International Congress of the International Society of Craniofacial Surgery tenutosi a Zambia nel 2011.
|Titolo:||Fat injections for the treatment of velopharyngeal insufficiency|
CANTARELLA, GIOVANNA (Primo) (Corresponding)
MAZZOLA, RICCARDO FRANCESCO (Secondo)
PIGNATARO, LORENZO (Ultimo)
|Parole Chiave:||velopharyngeal insufficiency; fat injection; hypernasality; technical details|
|Settore Scientifico Disciplinare:||Settore MED/31 - Otorinolaringoiatria|
|Data di pubblicazione:||mag-2012|
|Enti collegati al convegno:||International Society of Craniofacial Surgery|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1097/SCS.0b013e31824db85b|
|Appare nelle tipologie:||01 - Articolo su periodico|