First described in 1950 by Hynes for patients with velopharyngeal insufficiency following cleft palate repair, the sphincter pharyngoplasty is a frequently used procedure for treating velopharyngeal insufficiency that rivals the pharyngeal flap in some centers as the most frequently used procedure. This technique is most effective for patients with good anterior-posterior motion but limited lateral wall motion. The primary aims of this chapter are to provide the clinician with indications for when to consider utilizing the sphincter pharyngoplasty and to give a stepwise description of how to perform the procedure.