Uvulectomy (Uvula Excision) for Snoring
The uvula is the little dangling thing in the back of the mouth. It is also a significant factor in many patients with "socially-disruptive" snoring. When sleeping in these patients, the uvula flaps around causing the snore. Sometimes, these patients may complain of a mild sore throat when waking in the morning and the uvula may even be somewhat swollen as well.
The cure to snoring in these patients is to completely excise the uvula. This is a simple procedure that takes no more than 15 minutes to perform in the office. Local anesthesia alone is required without the need for sedation.
The Perfect Patient
The perfect patient who would most benefit from this procedure is someone who snores due mainly to uvula and does NOT have a bad gag reflex or documented obstructive sleep apnea. The best way to determine whether the uvula/palate is the main culprit in a patient's snore is by having him/her imitate the snore while the palate is being examined. How is this accomplished? The patient should bring his/her partner and reproduce the snore with his/her partner's confirmation. While the snore is reproduced, fiberoptic nasopharyngoscopy is performed and if the uvula and soft palate is shown to be vibrating, uvulectomy would be of benefit.
Another clue that the uvula may be responsible for a person's snore include:
- A uvula more than 1.5 cm in length
- The uvula tip instead of being rounded, ends like a needle, tapered to a point
Normal short uvula with rounded end.
Very long uvula.
Uvula that is tapered
For most people, a "uvular-palatal" snore that is amenable to this treatment sounds like this:
Sample Uvula/Palate Snore #1
Sample Uvula/Palate Snore #2
A tongue base snore that sounds like this does not respond well to this type of treatment:
Sample Tongue Base Snore
If you are able to imitate the snore while sticking out the tongue, the snore is most likely from the uvula/palate.
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 if removal is done correctly and conservatively. HOWEVER, some patients may experience a side effect of a chronic sensation of excess phlegm, globus, and dryness if too much uvula is removed. 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 and no more.
The procedure is performed in the following manner. You can watch a video of the procedure below.
The back of the mouth is anesthetized with topical 4% lidocaine.
The uvula region is injected with a local anesthetic.
Obviously, if the patient has a bad gag reflex, this step would be quite difficult to do.
Using electrocautery, the uvula is literally cut off, though care is taken to preserve the uvular musculature at the base otherwise significant side effects may occur (see below). Electrocautery is used since it both cuts and stops bleeding simultaneously. Almost no bleeding occurs with this procedure.
Many people inquire about use of a laser. Our office does not use a laser to perform this procedure due to increased risk of complications including lip and facial burns (imagine if a person moves due to gagging or a cough and the laser is turned on...).
As the area heals, there will be a whitish appearing eschar or scab. This is NORMAL. Think of a scab when it gets wet... it turns white. Given the mouth is wet all the time, this area will remain white until it completely heals. This usually takes about 3-4 weeks.
Without the uvula, the airway is a little bit larger. Furthermore, there is less tissue for vibration to occur resulting in a significantly reduced snore if not complete cure.
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, throat vibration, etc). Click here for more info.
Also, snoring may be indicative of an underlying medical condition like obstructive sleep apnea (OSA) for which treatment IS covered by insurance. Treatment for OSA often helps snoring as a bonus side effect. In order to determine if a person's snore is due to OSA, a sleep study needs to be performed which can only be prescribed by a physician. Watch the video below to see how a sleep study is performed at a sleep center.
Side Effects and Complications
After the procedure, there is signifiant pain for about 1 week after which the pain fairly quickly disappears. The first few days is the worst.
It is very important that the uvular base musculature be preserved otherwise significant side effects may occur related to velopharyngeal insufficiency which may cause a persistent sensation of 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.
Should this problem occur, endoscopic nasopharyngoscopy is typically performed to evaluate the presence and severity of the issue. Nasopharyngeal injection with a bulking agent (ie, prolaryn plus) will often help resolve this complication.
Other transient problems that may occur is excessive scarring analogous to keloids on the skin. Should this occur, steroid injections to the scar will often help.
If snoring and/or obstructive sleep apnea is affecting your quality of life, please contact our office for an appointment.
Related Blog Articles
- Singulair May Help Cure Mild Sleep Apnea in Children
- Oral Appliances to Help Correct Obstructive Sleep Apnea (OSA)
- What Does the Uvula Do?
- Sleep Apnea Can Mimic Dementia
- Layperson's Cure for Snoring and Obstructive Sleep Apnea?
- Tongue and Mouth Exercises May Help Reduce Snoring
- Didgeridoo Exercises of the Mouth and Throat Improves Sleep Apnea!!!
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