 MRI Neck:Relevant measurements for velopharyngeal insufficiency are as follows, although no volumetric measurements were made:HPL = 3.4 cmVL = approximately 3.0 cmVelar thickness = approximately 9 mmOPD = 3.3 cmOPD/VL = 1.1ACBA = 139 degreesPCBA = 160 degreesADA = 106 degreesVPW = 2.4 cmMPW = 3.2 cmPHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are unremarkable. Cleft palate evaluation is limited on this MR exam, although no gross defect is identified. The larynx is unremarkable. The trachea looks deviated slightly to the right but evaluation of this is limited given the curvature of the spine to the right which may be positional. The esophagus is unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered mildly enlarged nodes of Rouviere bilaterally measuring up to 1.6 cm and left submandibular lymph node measuring up to 1.6 cm which is nonspecific and likely reactive in etiology.OTHER: The visualized intracranial structures are unremarkable. Mild mid-face hypoplasia and low set ears are suggested. Hypertelorism is incidentally noted.Pulsation artifact limits evaluation of structures in the upper mediastinum, including the expected thymus. MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The right common carotid artery bifurcates at the upper aspect of the thyroid gland which is somewhat low but is of normal caliber. The left CCA bifurcates more cranially at a more normal level. The left vertebral artery is minimally dominant. There is no evidence of stenosis or occlusion.
1.Asymmetrically low bifurcation of the right common carotid artery at the level of the upper pole of the thyroid gland at approximate C5 level. The cervical vasculature is otherwise of normal course and caliber.2.Measurements compatible with velopharyngeal insufficiency as noted above including widened velopharynx and shorter hard palate, with associated platybasia. Cleft palate not grossly visualized on this MR exam.3.Mildly enlarged superior retropharyngeal lymph nodes and left submandibular lymph node which are nonspecific but most likely reactive in a patient of this age.