Safety and Efficacy Concerns of Autologous Fat Grafting for Velopharyngeal Insufficiency

Objective: Autologous fat grafting of the velopharynx has been well described for the treatment of velopharyngeal insufficiency (VPI), with most studies purporting it as a technique with low morbidity useful in the treatment of mild VPI. Prompted by 3 cases of obstructive sleep apnea (OSA) following fat grafting of the velopharynx, we undertook a review of the outcomes of this procedure at our unit. Design: Retrospective case series. Participants: All patients who underwent autologous fat grafting for VPI at the Royal Children's Hospital Melbourne. Main Outcome Measures: Preoperative nasendoscopy findings, perceptual speech assessment results, and rates of revisional surgery and complications. Results: Twenty-eight patients were included in the study. Three patients (11%) developed severe OSA requiring removal of the grafted fat. In a subanalysis of cleft patients, there was a reported improvement in hypernasality in 63% though only 25% had complete resolution of their hypernasality. Patients who had an improvement in speech were more likely to have a velopharyngeal gap of less than 0.5 cm(2) on preoperative nasendoscopy. All 3 patients who developed OSA had syndromes associated with hypotonia. Conclusions: This study raises serious concerns over the safety and efficacy of fat grafting for VPI. Overall, there was a relatively high complication rate with generally poor speech results in our series of patients. Stringent criteria should be used to select candidates for fat grafting, namely, a velopharyngeal gap less than 0.5 cm 2 and the absence of a syndrome associated with hypotonia.