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Tailored Posterior Pharyngeal Fat Grafting Outcomes in Velopharyngeal Insufficiency Managed According to a Simplified Algorithm

Denadai, Rafael MD; Raposo-Amaral, Cesar Augusto MD; Sabbag, Anelise SLP, Msc; Vieira, Pedro Ribeiro MD; Buzzo, Celso Luiz MD, Msc; Raposo-Amaral, Cassio Eduardo MD, PhD

doi: 10.1097/SAP.0000000000001930
Head and Neck Surgery
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Background This study aimed to evaluate the outcomes of posterior pharyngeal fat grafting for the management of velopharyngeal insufficiency using a simplified therapeutic algorithm and a tailored surgical technique.

Methods This was a prospective study of consecutive nonsyndromic patients with repaired cleft palate and velopharyngeal insufficiency who were stratified according to a simplified algorithm (minimally scarred palate, transverse orientation of levator veli palatini, and pinhole-to-small velopharyngeal gaps) and who underwent tailored posterior pharyngeal fat grafting. The patients were screened for obstructive sleep apnea before and after surgery. Three blinded evaluators randomly rated perceptual speech (hypernasality, audible nasal emission, and intraoral pressure) and nasoendoscopic (velopharyngeal active gap size) characteristics using audio and video recordings. Successful speech outcome was defined as normal or borderline sufficient velopharyngeal function at 15 months after surgery.

Results All included patients (n = 96) presented with a preoperative and postoperative low risk of obstructive sleep apnea. At 15 months after surgery, hypernasality (0.26 ± 0.53), audible nasal emissions (0.29 ± 0.48), intraoral pressure (0.1 ± 0.31), and velopharyngeal closure size (1.86 ± 0.34) were significantly decreased (all, P < 0.05) compared with the corresponding preoperative measurements (hypernasality, 2.17 ± 0.75; audible nasal emissions, 1.89 ± 0.82; intraoral pressure, 0.85 ± 0.35; and velopharyngeal closure size, 0.2 ± 0.49). In total, 84 (87.5%) patients showed successful speech outcomes.

Conclusions Tailored posterior pharyngeal fat grafting is an effective and safe surgical strategy for the management of velopharyngeal insufficiency in a selected cohort of patients with repaired cleft palate.

From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil.

Received November 4, 2018, and accepted for publication, after revision February 15, 2019.

Conflicts of interest and sources of funding: None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article. The authors report no financial support. The authors declare no conflict of interest.

Presentation History: Awarded “Ivo Pitanguy” Prize for best overall paper presentation at the 54th Brazilian Congress of Plastic Surgery, in Florianópolis, Brazil; November 15–18, 2017. Awarded “Shriners Hospitals for Children” Prize for best cleft presentation at the 54th Brazilian Congress of Plastic Surgery, in Florianópolis, Brazil; November 15–18, 2017.

Reprints: Rafael Denadai, MD, Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa 6028, Campinas, São Paulo 13084-880, Brazil. E-mail: denadai.rafael@hotmail.com.

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