Incorporating Velopharyngeal MRI into the Clinical Decision-Making Process for a Patient Presenting with Velopharyngeal Dysfunction Following a Failed Palatoplasty

Abstract

This clinical report describes the implementation of magnetic resonance imaging (MRI) to evaluate a patient with long-standing velopharyngeal dysfunction. She was referred to the craniofacial clinic at age 10 with no prior surgical history and subsequently completed a Furlow palatoplasty due to a suspected submucous cleft palate. However, results were unfavorable with minimal improvement in speech or resonance. The clinical presentation, treatment, outcomes, and contributions from MRI for secondary surgical planning are described. Addition of MRI into the clinical workflow provided insights into the anatomy and physiology of the velopharyngeal mechanism that were unable to be obtained from nasendoscopy and speech evaluation alone.

Keywords: MRI; velopharyngeal dysfunction.

Figure 1.

View of the image planes assessed for the patient reported in this case study. The oblique coronal callout (A) demonstrates key measures obtained from this slice including the extravelar and intravelar levator length (blue), VP port depth (orange), origin-to-origin distance of the levator veli palatini muscle and angles of origin (green), and levator veli palatini muscle thickness measures (purple). The midsagittal callout (B) demonstrates the key measures obtained from the midsagittal slice: curvilinear and effective velar length (gold), pharyngeal depth (orange), LVP insertion to posterior pharyngeal wall (dashed orange), velar thickness (green), adenoid thickness (pink), sagittal angle (purple), and cranial base angle (cyan).

Figure 2.

Post-palatoplasty comparison between the bird’s eye view as seen on nasendoscopy and the in-plane oblique coronal view as seen on MRI at rest and during sustained phonation.