We present the novel use of intraoperative magnetic resonance imaging (MRI) to evaluate cleft palate morphology and levator veli palatini (LVP) anatomy immediately before and after palatoplasty. A 4-year-old with Robin Sequence and a large palatal fistula underwent secondary repair with intraoperative imaging. Pre- and postoperative MRIs revealed increased LVP length (57.25-64.6 mm), thickness (4.25-7.2 mm), and velar length (10.46-29.0 mm), demonstrating improved muscular cohesion. Application of intraoperative MRI offers objective, real-time assessment of velopharyngeal structures, providing the potential to refine anatomical understanding and guide surgical decision-making for complex cases.
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