Injection pharyngoplasty with calcium hydroxyapatite for treatment of velopalatal insufficiency
ABSTRACT To evaluate the efficacy of injectable calcium hydroxylapatite for treatment of velopalatal (VP) insufficiency (VPI).
Observational case series of 7 patients treated with injectable calcium hydroxylapatite for VPI and followed for 10 to 24 months.
Academic pediatric otolaryngology practice.
Seven children aged 6 to 16 years with clinically significant VPI stemming from documented small VP gaps and who did not benefit from speech therapy were treated with calcium hydroxylapatite injection pharyngoplasty.
Posterior pharyngeal wall augmentation with calcium hydroxylapatite.
Treatment success was defined as (1) speech improvement to the degree that parents felt no additional treatment was needed and (2) meeting postoperative nasometric measures. Treatment failure was defined as parental report of insufficient improvement in speech. Complications and additional treatments for VPI were noted.
There were no major complications in any of the 7 children injected with calcium hydroxylapatite. There was 1 minor complication: 1 patient was readmitted for postoperative pain and dehydration. Of the 7 patients, 4 experienced a satisfactory result for up to 17 months. Findings from postoperative nasometry were either within reference range, or less than 1 SD greater than the reference range, for all sounds. There were 3 treatment failures, each with preexisting craniofacial abnormality. Two patients in the group that failed treatment later underwent revision superior pharyngeal flap surgery without complication or hindrance from the calcium hydroxylapatite injection. Four children underwent subsequent magnetic resonance imaging evaluations up to 1 year after injection, which revealed no evidence of migration.
The data from this small series suggest that posterior pharyngeal wall injection with calcium hydroxylapatite is safe and may be effective in treating select patients with VPI. Further longitudinal studies, with a larger series of patients, examining the safety, efficacy, and patient selection are warranted to better understand the possible use of posterior pharyngeal wall injection of calcium hydroxylapatite in children with symptomatic VPI.
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ABSTRACT: Dextranomer/hyaluronic acid copolymer implants are used in treating velopharyngeal insufficiency. These posterior nasopharyngeal implants can be mistaken for pathologic conditions such as retropharyngeal abscess on imaging. We studied the imaging appearance of dextranomer/hyaluronic acid copolymer implants in patients treated for velopharyngeal insufficiency. A consecutive series of patients with velopharyngeal insufficiency treated with dextranomer/hyaluronic acid copolymer were included in this study. Data on patient characteristics and volume of dextranomer/hyaluronic acid copolymer injected were obtained. Postoperative imaging characteristics on plain radiography, CT, and MR imaging were assessed. The imaging appearance of postoperative complications was determined. Sixteen patients were included in this study. Seven patients underwent postoperative plain radiographs, 5 patients underwent CT, and 9 patients underwent MR imaging. Plain radiographs demonstrated soft-tissue swelling in the retropharyngeal space, which resolved at 1 month. On CT, dextranomer/hyaluronic acid copolymer implants appeared as bilateral nasopharyngeal soft-tissue masses isoattenuated to hypoattenuated relative to muscle in 80% (4/5) of patients. On MR imaging, dextranomer/hyaluronic acid copolymer implants appeared as bilateral nasopharyngeal soft-tissue masses that were isointense to muscle on T1 (8/9, 88.9%) and hyperintense to muscle on T2 (8/9, 88.9%) and demonstrated no restricted diffusion (4/4, 100.0%) or peripheral enhancement (7/7, 100.0%). The normal postoperative findings of posterior nasopharyngeal dextranomer/hyaluronic acid copolymer injection on MR imaging is characterized by the presence of bilateral nasopharyngeal soft-tissue masses that are isointense to muscle on T1 and hyperintense on T2, with no restricted diffusion or peripheral enhancement. Velopharyngeal dextranomer/hyaluronic acid copolymer implants are iso- to hypoattenuated to muscle on CT and are not visible radiographically once associated implantation-related swelling has resolved. © 2015 American Society of Neuroradiology.American Journal of Neuroradiology 02/2015; DOI:10.3174/ajnr.A4246 · 3.68 Impact Factor
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ABSTRACT: Objective Velopharyngeal insufficiency (VPI) is a common problem after cleft palate repair, it leads to speech distortion with consequent affection of speech intelligibility. Many techniques have been used in the treatment of VPI with varying results and complications. The aim of this study was to evaluate the efficacy of trans-oral endoscopic cerclage pharyngoplasty in the treatment of VPI. Methods Eighteen patients with hypernasality after palatoplasty were subjected to trans-oral endoscopic cerclage pharyngoplasty. Pre and postoperative evaluation of velopharyngeal function were performed by using auditory perceptual assessment, nasometric assessment, and flexible nasopharyngoscopy. Results Significant postoperative improvement of speech parameters measured with auditory perceptual assessment were achieved, and the overall postoperative nasalance score was improved significantly for nasal and oral sentences. Also, flexible nasopharyngoscopy showed significant improvement of velopharyngeal closure. No marked postoperative complications were reported apart from throat pain and dysphagia that disappeared with time. Conclusions Trans-oral endoscopic cerclage pharyngoplasty is an effective method for the treatment of VPI.International journal of pediatric otorhinolaryngology 06/2014; DOI:10.1016/j.ijporl.2014.03.018 · 1.32 Impact Factor
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ABSTRACT: An organic liquid species, tributyl phosphate (TBP), was immobilized in sol–gel derived silica matrix by direct mixing into a silica sol. These mixtures spontaneously solidified due to the polycondensation of silica sol. The obtained glassy materials were completely solid and optically transparent. TBP was stably immobilized as indicated by the absence of the leakage from the surface. Although the stable immobilization was macroscopically observed even at ca. 70% of the volume fraction of TBP in the glass sample, the results of the thermogravimetry–differential thermal analysis, Fourier transform infrared spectroscopy and immersion tests in water suggested that TBP is not chemically bound to the silica matrix but topologically entrapped in the cage of siloxane bonds. The relatively high Vickers hardness indicated that the network of siloxane bonds envelopes the immobilized TBP molecules. The results of wide angle X-ray scattering showed that the unit length of the siloxane bond does not significantly depend on the volume fraction of TBP. The expansion in the volume due to the incorporation of TBP occurred not uniformly but quite locally at the spots at which TBP molecules were embedded. The formation of the network of siloxane bonds is enhanced in the vicinity of the enveloped TBP molecules because of its Lewis basicity at the phosphate group.Advanced Powder Technology 01/2010; 21(1):23-27. DOI:10.1016/j.apt.2009.09.001 · 1.64 Impact Factor