Streamlined Preoperative Evaluation of Velopharyngeal Dysfunction: A Single-Session Protocol for Speech MRI and Carotid MRA

Abstract

Objective

To evaluate the feasibility and utility of a dual-imaging protocol integrating speech magnetic resonance imaging (MRI) and carotid magnetic resonance angiography (MRA) for assessment of velopharyngeal dysfunction (VPD).

Design

Prospective case series.

Setting

Single tertiary care institution.

Patients

Six pediatric patients with VPD.

Main Outcome Measure(s)

Image quality, velopharyngeal and vascular assessment, and impact on surgical decision-making.

Results

Speech MRI consistently provided key velopharyngeal metrics, including levator veli palatini orientation and velopharyngeal gap size. Carotid MRA successfully mapped the vascular course, identifying one case of carotid medialization. Integration of both studies streamlined preoperative planning, influencing surgical technique selection and posterior pharyngeal flap design in cases with vascular anomalies.

Conclusion

A dual-imaging VPD protocol provides comprehensive anatomical and vascular data in a single nonsedated session. This approach enhances diagnostic accuracy, improves surgical planning, and reduces patient burden by eliminating the need for separate imaging sessions and repeated anesthesia exposure.