The Pediatric Neuroradiologist's Practical Guide to Capture and Evaluate Pre- and Postoperative Velopharyngeal Insufficiency

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FIGURE.
A, Coronal oblique T2 image along the plane of the LVP (blue outline, B and C) at the level of the velopharyngeal port during rest. The normal appearance of the LVP is T2-hypointense and intact along its length. B, Coronal oblique T2 with the velopharyngeal port appropriately open (green outline). C, Coronal oblique T2 during phonation with the velopharyngeal port appropriately closed. D, Sagittal midline T2 image through the head at rest showing the 50–60° coronal oblique plane (solid white line), effective length (green line), the total velar length (red line), and the palatal plane (dotted line). E and F, Sagittal midline T2 image during both i and s phonation, respectively. Note the appropriate elevation of the velum with closure of the velopharyngeal port as well as the tongue position.

Table 1:

The definitions for pertinent measurements for quantitatively examining VPI^{^a,44}

Variable	Description
Pharyngeal depth	Linear distance (mm) from PNS to PPW or adenoid pad as seen on the midsagittal image
Velar length	Curvilinear distance (mm) from the posterior nasal spine to the tip of the uvula as seen on the midsagittal image
VP ratio	Calculation obtained from the dividing velar length by pharyngeal depth
Effective velar length	Linear distance (mm) from the posterior border of the hard palate to the point of levator muscle insertion into the velum as seen on the midsagittal image
EVP ratio	Calculation obtained from dividing effective velar length by the pharyngeal depth
Adenoid depth	Linear distance (mm) along the palatal plane from the adenoid pad to the posterior end of the adenoid

Note:—PNS indicates posterior nasal spine; PPW, posterior pharyngeal wall; VP, velopharyngeal; EVP, effective VP.
↵a Adapted with permission from Perry JL, Kotlarek KJ, Sutton BP, et al. Variations in velopharyngeal structure in adults with repaired cleft palate. Cleft Palate Craniofac J 2018;55:1409-18.

Table 2:

The mean (SD) of pertinent variables for quantitively examining VPI and results of analysis of variance^{^a,^b,31}

Variable	Infants (4–23 mo.)	Children (4–9 yr)	Adolescents (10–19 yr)	Adults (20+ yr)
Pharyngeal depth	11.43 (4.46)	17.80 (4.79)	21.45 (4.62)	20.92 (4.14)
Velar length	20.27 (3.32)	27.63 (4.17)	30.98 (5.10)	34.85 (4.79)
VP ratio	2.08 (0.94)	1.70 (0.69)	1.51 (0.42)	1.73 (0.42)
Effective velar length	8.58 (1.46)	12.07 (2.43)	13.12 (3.32)	13.72 (3.46)
EVP ratio	0.89 (0.43)	0.74 (0.30)	0.63 (0.19)	0.67 (0.19)
Adenoid depth	11.36 (4.38)	9.66 (5.49)	9.96 (5.49)	5.18 (3.88)

Note:— EVP indicates effective velopharyngeal; VP, velopharyngeal.
↵a Measurements are listed in millimeters with the exception of VP ratio measures.
↵b Adapted from Haenssler et al.³¹ Table 3 which is copyrighted material and included here with the permission of the American Speech-Language-Hearing Association (ASHA).