Diagnostic Utility of Velopharyngeal MRI in Children With Unexplained Velopharyngeal Insufficiency.

ObjectiveTo explore the utility of velopharyngeal MRI in contributing additional diagnostic information for patients with velopharyngeal insufficiency (VPI) of unknown etiology.DesignRetrospective cohort study.SettingTertiary children's hospital.ParticipantsChildren with clinically significant VPI without a confirmed etiology.InterventionsStandardized perceptual speech assessment with nasometry, non-sedated MRI, and multidisciplinary review for treatment planning.Main Outcome MeasuresMRI-informed etiologic classification, anatomic and functional contributors to VPI, and management recommendations.ResultsAmong 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.ConclusionsMRI provided clinically meaningful diagnostic information beyond routine examination and informed management decisions for children with VPI.