Velopharyngeal insufficiency (VPI) is a serious and complex complication that can arise after primary palatoplasty.

Inadequate closure of the velopharyngeal sphincter leads to nasal air emission and unintelligible speech.

Multiple surgical approaches have been proposed for managing VPI.

At our institution, sphincter pharyngoplasty (SP) is the preferred surgical technique.

The impact of inset design on SP outcomes remains inadequately explored.

This study seeks to compare the long-term outcomes of ETE versus OL inset techniques in cleft patients undergoing SP, aiming to inform clinical decision-making in the surgical management of VPI.