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Objectives/Hypothesis: This study was aimed to compare the efficiency of the anterior palatoplasty and expansion sphincter pharyngoplasty (APwESP) technique for all patterns of velopharyngeal obstruction (anterior–posterior [APPC], lateral [LPC], or combined circular pharyngeal collapse [CPC]). Study Design: The study was designed as a randomized prospective trial at Kâtip Çelebi University, Atatürk Training, and Research Hospital. Methods: Patients only with velopharyngeal obstruction were included. Three groups were created according to the obstruction pattern (APPC, LPC, and CPC) for the study. Outcome parameters included patient's demographics, apnea‐hypopnea index (AHI), lowest oxygen saturation (LOS), Stanford subjective scale of snoring (SSSS), and Epworth sleepiness scale (ESS). Results: Thirty‐one (34.1%) patients were in APPC group, while 30 (33.0%) patients were in LPC, and 30 (33.0%) were in CPC group. Preoperatively for all patients, on average, AHI was 33.4 ± 13.6, SSSS was 8.3 ± 1.0, ESS was 16.5 ± 2.6, and LOS was determined as 85.5 ± 3.6. There was a significant postoperative improvement in all parameters for all patients. There was no significant difference in outcome parameters between the groups according to obstruction pattern postoperatively. After APwESP surgery, obstruction pattern was not a significant factor for AHI (P =.234), SSSS (P =.180), and LOS (P =.280) (repeated measure analysis of variance test). The rate of surgical success was detected similarly for both of the study groups (P =.435). The rate of successful surgery for severe obstructive sleep apnea in the APPC group was 72.2%, 88.2% in the LPC group, and 75.0% in the CPC group (P =.472). Conclusion: A combination of APwESP surgery can manage all types of pharyngeal obstruction confidently. Level of Evidence: 3 Laryngoscope, 132:1313–1319, 2022 [ABSTRACT FROM AUTHOR]