Autologous Fat Grafting for the Treatment of Mild to Moderate Velopharyngeal Insufficiency

To assess speech results following the treatment of mild to moderate velopharyngeal insufficiency (VPI) post cleft palate surgery with autologous fat grafting to the velopharynx.

A retrospective study was conducted on 9 consecutive patients who underwent velopharyngeal fat grafting for the treatment of VPI at the Red Cross War Memorial Children's hospital from 2010 to 2014. All the patients previously had primary palatoplasty performed and subsequently developed VPI. Patients were assessed pre- and postoperatively by an experienced speech and language therapist looking at perceptual speech and by 2 senior cleft surgeons interpreting lateral view videofluoroscopies.

Eleven fat grafting procedures were performed on 9 patients and an average of 5.64 mL (range 1-7 mL) of autologous fat was transferred to the velopharynx. The average age at the time of operation was 6.5 years (range 3-14 years) with a follow-up period of 18 months (range 7-34 months). Most of the patients (7 out of 9) showed improved speech after fat grafting. One of the 7 patients had multiple procedures. The 2 who did not show speech improvement only had a single procedure. There were no complications related to the fat grafting procedure.

This small study suggests that fat grafting either as a single procedure or as multiple procedures is an effective, safe, minimally invasive surgical alternative, and/or adjunct for the treatment of mild to moderate VPI in patients following cleft palate surgery and to the knowledge, is the first reported study from Africa.