Magnetic resonance imaging of the levator veli palatini muscle before and after primary palatoplasty

Objective: To explore the application of magnetic resonance imaging (MRI) in the evaluation of patients with cleft palate before and after primary palatoplasty with particular attention focused on the levator veli palatini muscle. Design: Prospective study using URIs of subjects before and after primary cleft palate surgery. Setting: Hospital and university based. Patients: One female infant with normal anatomy. Three male and four female infants with cleft palate of varying severity. Intervention: Furlow double-opposing Z-plasty and V-Y palatoplasty. Main Outcome Measures: Magnetic resonance images. Results: It was found that the levator veli palatini muscle can be imaged before and after palatal surgery in infants using MRI. The muscle may have sufficient volume, proportionate to a normal infant or adult, in infants born with cleft palate, if retrodisplaced properly, the muscle is likely to be steeper (more vertical) from its origin at the base of the skull to its insertion into the velum following palatoplasty, thus providing a more favorable angle for elevating the velum. Following palatal surgery, the levator muscle mass may not be as cohesive across the velar midline, compared with normal musculature. Conclusion: MRI is a viable imaging modality for the evaluation of the anatomy of the levator veli palatini muscle before and after primary palatoplasty in infants born with cleft palate.