Sphincter pharyngoplasty (SP) is frequently chosen by craniofacial surgeons and craniofacial teams for surgical management of velopharyngeal dysfunction (VPD), whether associated with unsuccessful cleft palate repair or with other causes. The goal of this operation is to narrow the central velopharyngeal (VP) orifice, thus minimizing airflow through the nose during speech. Sphincter pharyngoplasty tightens the central VP orifice without creating lateral ports, resulting in the opposite velopharyngeal configuration when compared with the pharyngeal flap (PF) procedure. The SP procedure rearranges palatopharyngeus myomucosal flaps raised from the posterior tonsillar pillars, which are transposed to the posterior pharyngeal wall and each other. A personal experience, in the context of an interdisciplinary cleft team over the past 30 years supports the logic that management of VPD, based on differential diagnosis and using SP, can achieve optimal results. The SP procedure, rationale for its use, and risks are reviewed.