Uvulopalatopharyngoplasty (UPPP) for Obstructive Sleep Apnea (OSA)

by , last modified on 9/23/16
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For a complete list of procedures to treat obstructive sleep apnea, click here.


One of the most common surgical procedures to treat obstructive sleep apnea (OSA) is uvulopalatopharyngoplasty otherwise known as UPPP. This is a surgical operation performed under general anesthesia in a hospital operating room. This procedure entails removal of both tonsils (if present), removal of the uvula, trimming the soft palate, and suture all cut edges together.

What this operation attempts to accomplish is to enlarge the airway opening at the mouth level as much as possible through tissue removal as well as induce as much scarring as possible which makes the throat less prone to collapse (as well as vibrate).

The Perfect Patient

The perfect patient who would most benefit from this procedure is someone with documented obstructive sleep apnea based on a sleep study (see below), failed using CPAP machine to resolve the OSA, and anatomic factors suggesting obstruction that is occurring at the mouth level. What are some of these anatomic factors an ENT surgeon looks for? They include a large soft palate with a long uvula and large tonsils. On fiberoptic nasopharyngoscopy, the lateral aspects of the throat collapses causing obstruction on Mueller's maneuver (nasal inhalation while the nose is pinched closed). To absolutely confirm uvulo-palatal factors causing obstruction, sedated endoscopy can be performed.

A "uvular-palatal" snore is often present:

Sample Uvula/Palate Snore #1
Sample Uvula/Palate Snore #2


A common question is whether the uvula is an important structure. The blunt answer is that the uvula plays absolutely no essential role. You will not miss it after it is gone. HOWEVER, some patients may experience a side effect of a chronic sensation of excess phlegm, globus, and dryness. The uvula has salivary glands and does help distribute saliva in the pharynx (like a windshield wiper). In order to minimize this potential side effect, only a conservative amount of the uvula is removed without removing any central palate.


videoWatch Video on UPPP

The Procedure

The procedure is performed in the following manner:

uppp

Step 1:

The patient is placed under general anesthesia and structures identified. Prior to any surgical excision, measurements are taken on how much palate is to be removed.

uppp

Step 2:

The tonsils are removed (if present), uvula is excised, and the soft palate trimmed. After these structures have been removed, all cut edges are sutured together with bio-absorbable stitches.

For those wondering, we use coblation to remove most of these structures.

uppp

Step 3:

Recovery takes about 3 weeks. During this recovery period, the patient has a pretty horrific sore throat and it is not unusual for an adult patient to lose 10-20 pounds given how bad the pain is.

If a patient looks in the back of the mouth, white plaque-like debris is seen throughout the surgical site. This is NORMAL! This debris is known as eschar and it basically is a scab that's wet. (Imagine looking at a scab elsewhere on the body after you take a shower.)

uppp

Step 4:

This is what the back of the throat area looks like about 6 weeks after a UPPP. By this point, a person should hopefully be sleeping much better!


However, even with this procedure, snoring may not completely go away as snoring may be due to many different other levels of the airway (ie, tongue vibration, nose vibration, cheek vibration, etc). Click here for more info.

Side Effects and Complications

After the procedure, there is signifiant horrific pain for about 2-3 weeks after which the pain slowly disappears. It is not unusual for adults to lose about 10 pounds during the recovery due to significant decrease in caloric intake due to the pain.

It is also very important that the uvular base musculature as well as enough of the inferior edge of the palate be preserved otherwise significant side effects may occur related to velopharyngeal insufficiency or scar hyper-constricture which may lead to a persistent sensation of foreign body, phlegm, dryness, sandpaper, etc in the back of the mouth. Worst case scenario is if TOO much is removed, food / liquid regurgitation into the nose will occur with swallowing.

If UPPP surgery may be helpful for a patient, but the risks are too much for a patient to consider, tonsillectomy alone can be pursued with potentially good results but with certain caveats. [More Info]

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Commonwealth Sleep Center and Fauquier Health Sleep Center performs sleep studies in our area. The video below was done at the Commonwealth Sleep Center in Gainesville, VA. If you are unable to view video, click here.


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Oral Appliances That MAY Help Snoring in Some Patients Due to Tongue Factors:


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Any information provided on this website should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment. Advertisements present are clearly labelled and in no way support the website or influence the contents.


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