Pensler, et al. states that they performed a sphincter pharyngoplasty on patients with a larger port preoperatively. The rationale for this decision was that the sphincter pharyngoplasty creates more muscle bulk in general in the velopharyngeal port. More surgical manipulation of the velopharyngeal structures is required with a larger port size. A larger pharyngeal flap increases the risk of nasal airway obstruction. The sphincter pharyngoplasty may have a higher success rate with a lower risk of obstructive sleep symptoms.
Most articles report nasal airway obstruction as a possible outcome of both procedures.
Patients with syndromes can further increase the risk of postoperative complications. For example, children with Pierre-Robin sequence have a risk of airway obstruction before the surgery is performed. Postoperatively, their risk for obstruction is even greater. Perhaps these children should be excluded from a study on the risk of nasal airway obstruction in the pharyngeal flap versus the sphincter pharyngoplasty to better assess the roles of each physiological factor. Wells, et al.