Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
IWK Health Centre, Division of Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada.
J Plast Reconstr Aesthet Surg. 2014 Jan;67(1):1-8. doi: 10.1016/j.bjps.2013.09.021. Epub 2013 Sep 20.
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.
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.
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.
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.
自体脂肪移植到软腭已经被描述为治疗软腭裂功能不全超过十年。本研究的目的是评估自体脂肪移植治疗软腭裂功能不全的效果。
通过计算机在多个数据库中进行搜索。纳入了涉及接受自体脂肪移植治疗软腭裂功能不全且至少报告了一项术前和术后评估指标的患者的研究。
系统搜索发现了十一项符合纳入标准的研究。这些研究均为病例系列或非对照观察性研究。有三项研究报告了单纯的后咽壁增厚，而八项研究涉及咽弓、软腭和/或后咽壁的增厚。一般来说，选择的患者在言语治疗方面已经达到了稳定期，且软腭闭合缺陷较小至中度。尽管大多数患者有腭裂的诊断，但接受过软腭裂成形术或其他相关诊断的比例差异很大。除了一项报告外，所有报告的结果评估都包括语音感知评估。客观指标，如鼻音和脂肪移植成活率，报告不一致。总的来说，脂肪移植治疗软腭裂功能不全的效果是可变的，取决于评估方式。有一例阻塞性睡眠呼吸暂停的报道。
尽管自体脂肪移植治疗软腭裂功能不全有潜在的益处，但仍存在一些问题，如患者选择、安全性以及最佳的移植物体积和注射部位。本综述强调需要标准化的评估方法以及前瞻性比较研究或随机对照试验，以将脂肪移植与已确立的软腭裂成形术技术进行比较，从而更好地确定其使用的适应证。
