Evaluation of Patients Operated Because of Velopharyngeal Insufficiency with Dynamic Magnetic Resonance Imaging

Aim: Nearly 30% of the patients with cleft palate need another surgery for velopharyngeal insufficiency. While
preoperative radiologic evaluation is necessary for planning, postoperative evaluation is also so important. In
this study, we plan to share our experience about evaluation of the velopharynx with dynamic MRI at patients
who were operated oving for velopharyngeal insuf ficiency.
Patients and Methods: The study included seventeen patients who were presented with velopharyngeal
insufficieny and we applied dynamic MRI for postoperative evaluation between April 2014 and May 2020.
Pharyngeal flap was applied for 7, posterior augmentation was performed for 7 (2 costal cartilaginous, 5 fat
graft) and myomucosal repair was done for 3 patients with submucosal cleft. Dynamic MRI were obtained
preoperatively and postoperatively at 3rd month. Postoperative results were evaluated with dynamic MRI.
Results: The study included seventeen patients, with an age range of 9-29 (mean 13± 2.5), 11 women (65%),
and 6 men (35%). Posterior wall located grafts were found at the second cervical vertebra and viable. While
there was no nasal air escape in superior pharyngeal flap applied patients at sagittal plane, in axial dynamic
images, gap was detected which is all essential for airway and must be obtained. The levator muscle direction
was observe normal postoperatively at patients with submucous clef. Nasal air escape area was decreased
in both methods significantly comparing with preoperative measu rement (p<0.05)
Conclusion: Because of the three-dimensional and dynamic structure of the velopharynx, it must be evaluated
in both planes and dynamic. Although there are many techniques for this purpose, none of them is ideal or
objective. Dynamic MRI can be used for postoperative follow-up as it is used for preoperative planning.
Evaluation of the pharyngeal flap atrophy , grafts and also gap size are provided with qualitative values .