Autologous fat grafting for the treatment of velopharyngeal insufficiency: State of the art

Background Autologous fat grafting to the velopharynx has been described for treatment of velopharyngeal insufficiency for over a decade. The aim of this review was to evaluate outcomes of autologous fat grafting for velopharyngeal insufficiency. Methods A computerized search was performed across multiple databases. Studies involving patients undergoing autologous fat grafting for velopharyngeal insufficiency treatment that reported at least one pre- and post-intervention outcome measure were included. Results A systematic search revealed eleven studies that satisfied inclusion criteria. All were case series or noncomparative observational studies. Three reported on isolated posterior pharyngeal wall augmentation, while eight involved augmentation of the pharyngeal arches, velum and/or posterior pharyngeal wall. In general, selected patients had plateaued with regards to speech therapy and had small-to-moderate velopharyngeal closure defects. Although most patients had a cleft palate diagnosis, the proportion that had previous velopharyngoplasty, or other related diagnoses was highly variable. In all but one report outcome measures included perceptual speech assessment. Objective measures such as nasalance and fat graft take were inconsistently reported. Overall, results of fat grafting for velopharyngeal insufficiency were variable and depended on assessment modality. One case of obstructive sleep apnea was reported. Conclusions Despite potential benefits of autologous fat grafting for velopharyngeal insufficiency, questions remain as to patient selection, safety, and optimal graft volume and injection sites. This review underscores the need for standardized assessment methods and prospective comparative studies or randomized controlled trials to compare fat grafting with established velopharyngoplasty techniques to better define indications for its use.