Adding Nanofat to Fat Grafting to Treat Velar Scarring in Velopharyngeal Incompetence

Despite improved surgical techniques in palatoplasty a number of patients will present post-operatively with incomplete velopharyngeal closure due to several reasons including inherent shortness of the palate or midline scar contracture. This incomplete closure of the velopharynx during speech, known as velopharyngeal incompetence (VPI) causes hypernasality and nasal turbulence during speech. Treatment options in severe cases include revisions, pharyngeal flaps, and pharyngoplasties while in mild cases fat grafting has demonstrated its efficacy in improving velopharyngeal closure. Nevertheless, midline scarring can cause velar rigidity and inelasticity giving rise to inadequate velar elevation and retro position. Management of retracting velar scars is a real challenge. Despite an accurate surgical correction retracting scars tend to recur with negative effects on speech. Emulsified fat (nanofat) has proven to be a relevant source of stem cells and growth factors and has been successfully employed so far for the treatment of facial wrinkles and scars. The aim of this paper is to propose the application of the nanofat technique for the improvement of velar scar elasticity and pliability in addition to fat grafting to the posterior pharyngeal wall and the tonsillar pillars to further improve results when treating mild VPI. Studies with larger samples should follow to substantiate our findings but based on our preliminary experience, the authors feel that the nanofat could be a promising adjunct to the current repair procedures, due to its regenerative properties.