Abstract
OBJECTIVE
The aim of the study was to evaluate the effectiveness of fat injections in improving voice resonance and reducing nasal air escape in cases of velopharyngeal insufficiency (VPI).
METHOD
This prospective study, performed in a university hospital, involved nine patients (five adults aged 21-48, and four children aged 5-14) with VPI secondary to a submucous cleft (1), short palate (2), or previous cleft palate surgery (6), who were pre- and postoperatively assessed by means of flexible nasendoscopy to evaluate the gap site and size; perceptual evaluations of speech intelligibility, nasality and nasal air escape by means of a 5-point scale (0 = no disturbance; 4 = severe disturbance); and pneumotachographic assessment of the ratio between nasal airflow and total exhaled airflow during phonation. The lipoaspirate was centrifuged at 1200 g for 3' to separate and remove blood, cell debris and the oily layer, and the patients were injected 4.5-7 cc of fat in the posterior and lateral pharyngeal walls and soft palate under general anesthesia. Data were compared using Wilcoxon's non-parametric matched pairs test. Follow-up was 1-13 months.
RESULTS
Nasendoscopy revealed a significant reduction in the closure gap in all patients, and the perceptual evaluation demonstrated improved speech intelligibility and resonance and reduced nasal air leakage in all cases (p<0.05). The aerodynamic assessment showed a significant reduction in nasal airflow during phonation (p<0.05).
CONCLUSION
Fat injections improve voice resonance and reduce nasal air escape in VPI. A longer follow-up is necessary to evaluate the long- term results.