The Safe Treatment of Mild Velopharyngeal Insufficiency (VPI) with Autologous Fat Grafting

Velopharyngeal insufficiency (VPI) is defined as the incomplete closure of the passage between oro- and nasopharynx. Surgical management of VPI aims at improving voice resonance and correcting the airflow through the nose by restoring a competent velopharyngeal sphincter. Assessment of VPI requires the evaluation of multiple variables from perceptual evaluation of speech to aerodynamic measurement of nasal air escape. A team approach for the study of the activity of the velopharyngeal port (VP) during speech and for the assessment of the size of the closure gap, using video-assisted nasendoscopy and/or videofluoroscopy, is of paramount importance for establishing the proper type of surgical procedure. Fat injection in the posterior pharyngeal wall, in the soft palate and in the posterior pillars, represents a minimally invasive procedure with respect to major surgery in the management of mild-to-moderate VPI and minimizes the risk of complications. It constitutes a versatile procedure that can be performed without modifying the anatomy of the VP port. Blunt cannulas must be used to avoid the risk of injecting fat into the vessels, which course in the posterior and lateral pharyngeal wall. Safety is essential.