Diagnostic Utility of Velopharyngeal MRI in Children With Unexplained Velopharyngeal Insufficiency

Objective To explore the utility of velopharyngeal MRI in contributing additional diagnostic information for patients with velopharyngeal insufficiency (VPI) of unknown etiology. Design Retrospective cohort study. Setting Tertiary children's hospital. Participants Children with clinically significant VPI without a confirmed etiology. Interventions Standardized perceptual speech assessment with nasometry, non-sedated MRI, and multidisciplinary review for treatment planning. Main Outcome Measures MRI-informed etiologic classification, anatomic and functional contributors to VPI, and management recommendations. Results Among 89 children, six (6.7%) presented with clinically significant VPI of unknown etiology on routine examination. MRI identified occult submucous cleft palate or atypical levator veli palatini morphology in five (83.3%) and adenoid-supported VP closure in three (50%). Involution was expected to unmask increased pharyngeal depth in two (33.3%). MRI supported patient-specific recommendations for speech therapy, surgical interventions, and longitudinal monitoring. Conclusions MRI provided clinically meaningful diagnostic information beyond routine examination and informed management decisions for children with VPI.