Magnetic resonance imaging in the evaluation of occult submucous cleft palate

Objective: To explore the application of magnetic resonance imaging (MRI) i n the evaluation of patients with occult submucous cleft palate and to use the MRI information obtained to aid in the treatment decision to perform su rgery versus behavioral speech therapy. Design: Prospective study with magnetic resonance (MR) images of subjects s uspected of having occult submucous cleft palate. Setting: Hospital and university-based. Patients: Two girls who were 4 years old at the time of palatal surgery. Intervention: Furlow double-opposing Z-plasty. Main outcome measures: MR images and clinical speech evaluations. Results: MR images provided evidence of an interruption of levator veli pal atini muscle tissue in the midline and a substantial attachment of levator muscle tissue to the posterior border of the hard palate. In addition, MR i mages for both subjects demonstrated remarkably similar bilateral encapsula ting sheaths that contained nonmuscular tissue, as confirmed subsequently d uring surgery. The encapsulating sheaths interrupted the normal progression of the levator muscle sling across the midline. The MR images led to the d ecision to perform surgery instead of speech therapy. Hypernasality was mar kedly reduced in both subjects after surgery. Conclusions: MRI is an effective technique for diagnosing occult submucous cleft palate and may be an important aid in the treatment decision regardin g surgery versus behavioral speech therapy for patients diagnosed with occu lt submucous cleft palate.