Canady J W, Thompson S A, Moon J B, Glowacki R L
Department of Surgery, University of Iowa, Iowa City, USA.
Cleft Palate Craniofac J. 1995 Jan;32(1):1-6. doi: 10.1597/1545-1569_1995_032_0001_aootir_2.3.co_2.
Patients with mild velopharyngeal incompetence (VPI) may have speech disorders, which are not sufficiently severe to warrant extensive surgical intervention, yet may not be amenable to correction by speech therapy alone. Augmentation of the posterior pharyngeal wall to aid in closure of the velopharyngeal sphincter may be beneficial in establishing better speech patterns, especially when combined with speech therapy. A variety of materials and techniques have been used in the past for this purpose. In this setting, autogenous fat may be transplanted without the risks incurred by augmentation with synthetic materials and involves very little donor site morbidity. The literature is somewhat contradictory, however, regarding the stability of the augmentation achieved using autogenous fat and there are no histologic studies describing the fate of fat injected into tissues of the oral cavity. Prior to introduction of this technique into clinical practice, this study was designed to investigate the fate of autogenous fat injected submucosally in the oropharyngeal region. Autogenous fat was injected into the anterior soft palate using the rabbit as a model. Histologic and gross inspections were performed at 2 days, 1, 2, and 4 weeks after injections. At the end of 4 weeks, at least 50% of the injection sites had visible evidence of augmentation, and 90% had histologic evidence of submucosal fat. In some instances most of the fat was resorbed; however, there were no instances of clinical infection or necrosis of the injection site. We conclude that submucosal injection of autogenous fat is a feasible alternative to using synthetic or other biologic materials for augmentation in the oral cavity.
轻度腭咽闭合不全（VPI）患者可能存在言语障碍，其严重程度不足以进行广泛的手术干预，但仅靠言语治疗可能也无法纠正。增加咽后壁厚度以辅助腭咽括约肌闭合，可能有助于建立更好的言语模式，尤其是与言语治疗相结合时。过去曾使用多种材料和技术来实现这一目的。在这种情况下，自体脂肪移植不存在使用合成材料进行增厚所带来的风险，且供区并发症极少。然而，关于使用自体脂肪增厚的稳定性，文献中的说法有些矛盾，并且没有组织学研究描述注入口腔组织中的脂肪的命运。在将该技术引入临床实践之前，本研究旨在调查口咽区域黏膜下注射自体脂肪后的命运。以兔子为模型，将自体脂肪注入软腭前部。在注射后2天、1周、2周和4周进行组织学和大体检查。在4周结束时，至少50%的注射部位有明显的增厚迹象，90%有黏膜下脂肪的组织学证据。在某些情况下，大部分脂肪被吸收；然而，没有出现注射部位临床感染或坏死的情况。我们得出结论，黏膜下注射自体脂肪是在口腔中使用合成材料或其他生物材料进行增厚的一种可行替代方法。
