Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is preformed to decrease apnea and hypoapnea events in patients with obstructive sleep apnea and improve and decrease snoring. UPPP removes all or part of the uvula (the soft flap of tissue that hangs down at the back of the mouth) and parts of the soft palate and the throat tissue behind it. If tonsils and adenoids are present, they are removed. In our practice we like to preserve much of the uvula muscle and remove the excess soft tissue around the muscle. The uvula aids in keeping the throat moist and it prevents air escape into the nasal cavity during speech causing a nasal voice also known as Velopharyngeal Insufficiency (VPI). The uvula muscle also prevents escape of liquids and food particles into the nasal cavity during swallowing also known as regurgitation. The goal of UPPP is to increase the width of the airway at the throat's opening, improve the ability of the airway to remain open and improve the movement and closure of the soft palate.

Success rates for UPPP in obstructive sleep apnea patients are as high as 65% and low as 35% and often deteriorate with time, averaging about 50% over the long term. The success rate is multifactor but the main factors are the severity of sleep apnea and the anatomical location of blockage of air exchange. Research suggests that UPPP is best suited for patients with abnormalities in the soft palate and mild to moderate obstructive sleep apnea. Results are poor if the problems involve other anatomical locations such as the nasal cavity or tongue area. Research has shown the success rate of UPPP increase up to 80% when this procedure is combined with Genioglossal advancement (moving the tongue forward). New data emerging from research centers are also showing improved outcome when UPPP is combined with Radiofrequency of the soft palate or the Pillar procedure. The greatest success rate has been achieved with CPAP compliant patients. CPAP is still the gold standard in treatment of obstructive sleep apnea but with the lowest compliance rate. Many or most patients with moderate or severe sleep apnea will likely still require CPAP treatment after UPPP alone. The best success rate in a surgical procedure in patients with moderate to severe obstructive sleep apnea has been achieved with double jaw advancement also known as Maxillo-Mandibular Advancement (MMA), which is as high as 95%. Some of the patients that undergo MMA procedure will not require CPAP.

Uvulopalatopharyngoplasty is preformed at a hospital setting under general anesthesia with 24 hours post surgical monitor or longer depending on patient’s medical condition and severity of obstructive sleep apnea. This procedure is also preformed at an out patient surgical setting with general anesthesia with 12 hours or less monitoring depending if the patient is just snoring or has mild obstructive sleep apnea and no morbid medical condition. Patients generally complain of sore throat, difficulty swallowing and changes in speech which is temporary. The procedure also has a number of potentially serious complications including:

• Infection. Preventive antibiotics administered an hour before surgery can help reduce this risk.
• Impaired function in the soft palate and muscles of the throat called Velopharyngeal Insufficiency, which can effect speech (hyper-nasal Speech).
• The feel of a mucus or dry throat
• Swallowing problem
• Regurgitation of fluids through the nose or mouth
• Impaired sense of smell
• Opening of the wounds
• Failure and recurrence of apnea. In such cases, patients with mild OSA are placed on oral appliance, radiofrequency or Pillar procedure. Patients with moderate to severe OSA are treated with CPAP or Double jaw advancements (MMA).

In general, only a small percentage of patients experience serious complications. Many of these complications can be avoided with proper technique and experienced surgeon. A patient's health status, including presence of obesity and severity of obstructive sleep apnea, may also affect outcomes.