Novel Quantification of the Levator Veli Palatini for Cleft Palate Repair via Intraoperative MRI

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.