A Novel Surgical Approach for Velopharyngeal Closure in Cleft Palate Patients Using Modified Endoscopic Soft Palate Augmentation

ObjectivePharyngeal flap transplantation improves velopharyngeal insufficiency after cleft palate surgery; however, the surgical timing remains controversial. In 2023, we reported the endoscopic soft palate augmentation (ESPA) technique, wherein fat is injected into the nasal side of the soft palate using an endoscope. It enhances the velopharyngeal closure function until pharyngeal flap transplantation. Herein, we present an improved version of ESPA.DesignCase series.SettingSingle-center study.PatientThree patients who had undergone palatoplasty were treated with the modified ESPA: a 10-year-old boy with BCLP, a 15-year-old boy with UCLP, and a 16-year-old girl with UCLP.InterventionWhile in the conventional ESPA, the endoscope and injection needle were integrated, in the improved ESPA, they were separate, marking a significant change. Moreover, the improved ESPA uses a 120-mm epidural needle to access the nasal side of the soft palate through the nostril.Main Outcome MeasuresWe believe the force needed for fat injection has been reduced, leading to less fat spillage at the syringe-needle attachment site and wastage. It also became easier to access the designated puncture site.ResultThe time taken for fat injection improved to an average of 16.0 min (conventional method: average 65.8 min) compared to that with conventional ESPA (5 cases). Additionally, the amount of fat required was halved to an average of 4.2 mL (conventional method: average 8.0 mL).ConclusionsThe enhanced ESPA technique reduces the amount of fat to be harvested and shortens the operation time, indicating that it is less invasive than the conventional ESPA.