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Velopharyngeal insufficiency managed by autologous fat grafting in patients with aberrant courses of internal carotid arteries.

Abstract Velopharyngeal insufficiency (VPI) is usually managed, besides speech therapy, by performing a velopharyngoplasty. An alternative approach is autologous fat grafting (AFG) of the posterior pharyngeal wall. About 5% of the population has internal carotid arteries (ICA) with an aberrant course. This anatomic variation can be responsible for surgical difficulties while when performing a velopharyngoplasty, and therefore lead surgeons to only consider a speech reeducation of VPI. However, AFG is does not bear such surgical morbidity.
PMID
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Authors

Mayor MeshTerms
Keywords

22q11 microdeletion

Aberrant internal carotid artery

Autologous fat grafting

Borel-Maisonny score

Journal Title international journal of pediatric otorhinolaryngology
Publication Year Start




PMID- 28390603
OWN - NLM
STAT- MEDLINE
DA  - 20170409
DCOM- 20170517
LR  - 20170517
IS  - 1872-8464 (Electronic)
IS  - 0165-5876 (Linking)
VI  - 96
DP  - 2017 May
TI  - Velopharyngeal insufficiency managed by autologous fat grafting in patients with 
      aberrant courses of internal carotid arteries.
PG  - 135-139
LID - S0165-5876(17)30103-9 [pii]
LID - 10.1016/j.ijporl.2017.03.012 [doi]
AB  - INTRODUCTION: Velopharyngeal insufficiency (VPI) is usually managed, besides
      speech therapy, by performing a velopharyngoplasty. An alternative approach is
      autologous fat grafting (AFG) of the posterior pharyngeal wall. About 5% of the
      population has internal carotid arteries (ICA) with an aberrant course. This
      anatomic variation can be responsible for surgical difficulties while when
      performing a velopharyngoplasty, and therefore lead surgeons to only consider a
      speech reeducation of VPI. However, AFG is does not bear such surgical morbidity.
      OBJECTIVE: The aim of this study is to retrospectively determine AFG efficiency
      on VPI in patients with aberrant ICA's courses who cannot benefit from a
      velopharyngoplasty, by comparing pre- and postoperative Borel Maisonny score
      (BMS) and intelligibility (Intell). METHODS: We conducted a retrospective study
      in 2 centers, including children with VPI and aberrant ICA's courses who
      underwent an AFG of the posterior pharyngeal wall from 2004 to 2015, in addition 
      to speech therapy. RESULTS: Nine patients (4-11 years old) underwent the surgical
      procedure, 8 of them presenting a 22q11 microdeletion. All improved their VPI by 
      AFG of the pharyngeal wall according to BMS and Intelligibility after a 10 months
      follow-up. The effect was stable after 3 years of follow-up. No severe
      complication (apnea, vascular injury) occured. CONCLUSION: AFG of the pharyngeal 
      wall, associated with speech therapy, seems to be a safe procedure for patients
      with VIP and aberrant ICA's courses. Multiple procedures are possible if needed.
CI  - Copyright (c) 2017 Elsevier B.V. All rights reserved.
FAU - Bois, Emilie
AU  - Bois E
AD  - Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital,
      Paris, France. Electronic address: [email protected]
FAU - Celerier, Charlotte
AU  - Celerier C
AD  - Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital,
      Paris, France. Electronic address: [email protected]
FAU - Belhous, Kahina
AU  - Belhous K
AD  - Radiology Department, Necker Enfants Malades Hospital, Paris, France. Electronic 
      address: [email protected]
FAU - Maulet, Michel
AU  - Maulet M
AD  - Speech Therapist, Necker Enfants Malades Hospital, Paris, France.
FAU - Leboulanger, Nicolas
AU  - Leboulanger N
AD  - Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital,
      Paris, France. Electronic address: [email protected]
FAU - Garabedian, Noel
AU  - Garabedian N
AD  - Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital,
      Paris, France. Electronic address: [email protected]
FAU - Denoyelle, Francoise
AU  - Denoyelle F
AD  - Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital,
      Paris, France. Electronic address: [email protected]
LA  - eng
PT  - Journal Article
DEP - 20170307
PL  - Ireland
TA  - Int J Pediatr Otorhinolaryngol
JT  - International journal of pediatric otorhinolaryngology
JID - 8003603
SB  - IM
MH  - Adipose Tissue/*transplantation
MH  - Carotid Artery, Internal/*abnormalities
MH  - Child
MH  - Child, Preschool
MH  - Computed Tomography Angiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Pharynx/*surgery
MH  - Retrospective Studies
MH  - Speech
MH  - Speech Disorders/etiology
MH  - Transplantation, Autologous/methods
MH  - Treatment Outcome
MH  - Velopharyngeal Insufficiency/*surgery
OTO - NOTNLM
OT  - 22q11 microdeletion
OT  - Aberrant internal carotid artery
OT  - Autologous fat grafting
OT  - Borel-Maisonny score
EDAT- 2017/04/10 06:00
MHDA- 2017/05/18 06:00
CRDT- 2017/04/10 06:00
PHST- 2017/01/23 [received]
PHST- 2017/03/03 [revised]
PHST- 2017/03/04 [accepted]
AID - S0165-5876(17)30103-9 [pii]
AID - 10.1016/j.ijporl.2017.03.012 [doi]
PST - ppublish
SO  - Int J Pediatr Otorhinolaryngol. 2017 May;96:135-139. doi:
      10.1016/j.ijporl.2017.03.012. Epub 2017 Mar 7.

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