Injection pharyngoplasty with calcium hydroxyapatite for treatment of velopalatal insufficiency

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA.
Archives of Otolaryngology - Head and Neck Surgery (Impact Factor: 1.75). 04/2008; 134(3):268-71. DOI: 10.1001/archotol.134.3.268
Source: PubMed

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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: This article reviews the most current practice guidelines in the diagnosis and management of patients born with cleft lip and/or palate. Such patients frequently have multiple medical and social issues that benefit greatly from a team approach. Common challenges include feeding difficulty, nutritional deficiency, speech disorders, hearing problems, ear disease, dental anomalies, and both social and developmental delays, among others. Interdisciplinary evaluation and collaboration throughout a patient's development are essential.
    Otolaryngologic Clinics of North America 10/2014; 47(5):821–852. DOI:10.1016/j.otc.2014.06.010 · 1.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the past decade, there has been increased utilization of magnetic resonance imaging (MRI) in evaluating and understanding velopharyngeal insufficiency (VPI). To our knowledge, none of the prior studies with MRI has simultaneously linked the audio recordings of speech during cine MRI acquisition with the corresponding images and created a video for evaluating VPI.
    Pediatric Radiology 08/2014; DOI:10.1007/s00247-014-3141-7 · 1.65 Impact Factor
  • [Show abstract] [Hide abstract]
    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 · 0.85 Impact Factor