Assessment of levator veli palatini muscle morphology and its correlation with velopharyngeal function using dynamic magnetic resonance imaging in children with repaired cleft palate

Understanding the underlying anatomic variability of the levator veli palatini (LVP) and relationships among velopharyngeal structures is important for effective treatment of velopharyngeal insufficiency (VPI) following cleft palate surgery. This study was designed to reveal potential correlations between LVP muscle characteristics and velopharyngeal competence using dynamic evaluation in pediatric patients with repaired cleft palates. LVP muscle variations were further examined according to sex, cleft type, timing of cleft palate repair, and surgical techniques. A retrospective analysis was conducted in pediatric patients with repaired cleft palates who underwent velopharyngeal Magnetic resonance imaging (MRI) between June 2020 and June 2023. Three-dimensional volumetric MRI scans were acquired for LVP muscle evaluation and dynamic MRI was used to evaluate upward and backward velar movement. A total of 66 pediatric patients aged 5–14 years with previously repaired cleft palates underwent velopharyngeal evaluation using MRI. No statistically significant differences were observed in the LVP muscle measurements among the cleft palate types, palatoplasty timing, and surgical techniques. Patients with VPI exhibited significantly shorter LVP and extravelar LVP muscle lengths (p<0.001) than those without VPI. Velar movements were strongly associated with levator muscle measurements. Greater LVP and extravelar LVP muscle lengths represented greater superior and posterior movement of the velopharynx, which significantly reduced VPI (p<0.001). The findings of this study may be integrated into preoperative assessments, contribute to surgical planning, aid in the evaluation of postoperative outcomes, and serve as a guide for future studies investigating similar variables in individuals with cleft palates.