Sphincter Pharyngoplasty for Velopharyngeal Dysfunction

The surgical correction of velopharyngeal insufficiency (VPI) seeks to augment the deficient aspect of the velopharyngeal apparatus. The objective of the sphincter pharyngoplasty is to narrow the velopharyngeal gap transversely by addressing lateral pharyngeal wall motion. Superiorly based lateral palatopharyngeus myomucosal flaps are transposed 90 degrees and inset into the posterior pharyngeal wall mucosa. Following sphincter pharyngoplasty, the patient is monitored overnight for impending airway compromise. If symptomatic VPI persists, repeat diagnostic evaluation is performed. Success is determined by acceptable perceptual oral resonance, adequate velopharyngeal closure on endoscopy, and the absence of upper airway obstruction or sleep apnea.