背景:咽喉功能不全(VPI)是一种特征为在讲话过程中口腔和鼻腔不完全分离的疾病,从而导致言语异常和听得见的鼻发射。随后,这对沟通和潜在的人际交往产生了不利影响。自体脂肪移植(AFG)到喉部,一种微创技术,旨在通过提供体积和向软腭推进咽后壁来改善口鼻分离。尽管有潜力,AFG治疗VPI的相对新颖性导致报告不一致的适应症,多种手术技术,以及现有文献中混合的结果。
方法:本系统综述审查了过去十年(2013-2023年)AFG用于VPI治疗的证据。对五个电子数据库进行了彻底搜索,得出了233项研究,20个符合纳入标准(例如,利用脂肪注射作为他们选择的VPI治疗,在人类受试者中进行的研究,在脂肪注射时没有进行额外的外科手术)。选定的研究包括患者和手术干预的特点,感知言语评估(PSA)得分,间隙大小,nasalance测量,和并发症。
结果:大多数患者先前有腭裂诊断(78.2%),其中鼻内窥镜检查是可视化咽喉端口缺损的常用方法。脂肪采集主要发生在腹部(64.3%),所有研究的平均注射量为6.3mL。术前PSA和主观间隙大小评分始终高于术后。七项研究的PSA评分分析显示,术后有显著和持续的改善。来自四项研究的间隙大小评分分析显示相似的术前和术后差异。17项研究报告了并发症,594例患者并发症发生率为2.7%。
结论:自体脂肪移植已成为一种微创,安全,对轻度至中度VPI的有效治疗。然而,由于患者选择标准的可变性,挑战仍然存在,诊断方式,和结果测量。这篇综述强调了随机对照试验的必要性,以直接比较AFG与标准护理手术干预措施。为其临床疗效提供更确凿的证据。
BACKGROUND: Velopharyngeal insufficiency (VPI) is a condition characterized by incomplete separation of the oral and nasal cavities during speech production, thereby leading to speech abnormalities and audible nasal emissions. Subsequently, this adversely impacts communication and potentially interpersonal social interactions. Autologous fat grafting (AFG) to the velopharynx, a minimally invasive technique, aims to improve oronasal separation by providing bulk and advancing the posterior pharyngeal wall toward the soft palate. Despite its potential, the relative novelty of AFG in treating VPI has resulted in reporting of inconsistent indications, varied surgical techniques, and mixed outcomes across existing literature.
METHODS: This systemic
review examined the evidence of AFG for VPI treatment over the past decade (2013-2023). A thorough search across five electronic databases yielded 233 studies, with 20 meeting the inclusion criteria (e.g., utilized fat injection as their selected VPI treatment, conducted study in human subjects, did not perform additional surgical procedure at time of fat injection). Selected studies encompassed patient and surgical intervention characteristics, perceptual speech assessment (PSA) scores, gap sizes, nasalance measurements, and complications.
RESULTS: The majority of patients had a prior cleft palate diagnosis (78.2%), in which nasoendoscopy was the prevalent method for visualizing the velopharyngeal port defect. Fat harvesting predominantly occurred from the abdomen (64.3%), with an average injection volume of 6.3 mL across studies. PSA and subjective gap size scores were consistently higher preoperatively than postoperatively. PSA score analysis from seven studies revealed significant and sustained improvements postoperatively. Gap size score analysis from four studies demonstrated similar preoperative and postoperative differences. Complications were reported in 17 studies, yielding a 2.7% summative complication rate among 594 cases.
CONCLUSIONS: Autologous fat grafting has emerged as a minimally invasive, safe, and effective treatment for mild to moderate VPI. However, challenges remain because of variability in patient selection criteria, diagnostic modalities, and outcome measurements. This
review underscores the need for randomized control trials to directly compare AFG with standard-of-care surgical interventions, providing more conclusive evidence of its clinical efficacy.