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1Division of Plastic Surgery, University of Missouri; 2Fontbonne University, St Louis, Missouri, USA Correspondence: Dr Arshad R Muzaffar, Division of Plastic Surgery, University of Missouri, One Hospital Drive, Columbia, Missouri 65212, USA. Telephone 573-882-2275, fax 573-884-4788, e-mail [email protected] Sphincter pharyngoplasty has shown time-tested results as a surgical treatment for velopharyngeal incompetence (VPI). On its introduction by Hynes in 1950 (1), it was believed that with its use, velopharyngeal closure would be augmented not only by narrowing the lateral extents of the velopharyngeal port, but would be further improved by the contractile properties of the muscles (originally the salpingopharyngeus, later including the palatopharyngeus). Since then, this notion has come under scrutiny. In 1998, Witt et al (2) reviewed preand postoperative videofluoroscopies to account for minimal and maximal excursion of the sphincter in the basal view. In this study, the authors concluded that sphincter pharyngoplasty appeared to be dynamic after the majority of their surgeries. In a follow-up study the same year, Witt et al (3) questioned whether the dynamism of the sphincter was due to pre-existing posterior pharyngeal wall motion. They performed lateral videofluoroscopic evaluations preoperatively and postoperatively for 20 patients who underwent sphincter pharyngoplasty and concluded that after comparing preoperative and postoperative parameters, the surgery did not significantly affect posterior pharyngeal wall motion and that preexisting posterior pharyngeal wall motion was not the cause of sphincter dynamism. Georgantopoulou et al (4) used tracings of a velopharyngeal port made from preand postoperative videofluoroscopies to measure velar elevation associated with port closure in patients who had undergone oRiginal aRtiCle