Introduction
Uvulopalatopharyngoplasty (UPPP) procedure was first introduced in 1981 by Fujita and colleagues. This surgical procedure is intended to treat obstructive sleep apnea (OSP) by increasing the upper airway pathway by resecting tissues in the throat, such as the uvula, soft palate, and tonsils. This can also be done in patients with the problem of snoring.
Uvulopalatopharyngoplasty (UPPP) is currently the most common surgery performed in the USA for patients with obstructive sleep apnea (OSA).
What Is Obstructive Sleep Apnea?
Obstructive sleep apnea is one of the most common sleep-related breathing disorders characterized by the collapse of the pharyngeal airway during sleep. It causes repetitive, irregular breathing while sleeping. One of the most common signs of obstructive sleep apnea is snoring.
Obstructive sleep apnea can lead to behavioral and cardiovascular problems, and it is estimated to be present in 1 of 20 adults, and in five percent of cases, it remains undiagnosed.
Tracheostomy is considered the best treatment for obstructive sleep apnea until 1981. Lifestyle modifications, CPAP (continuous positive airway pressure), and weight loss were the first line of treatment for obstructive sleep apnea. If these procedures fail to treat this condition, uvulopalatopharyngoplasty and other surgical treatments might be done.
What Is Uvulopalatopharyngoplasty Surgery?
Uvulopalatopharyngoplasty surgery helps in removing and repositioning tissue present in the airway to not interfere with breathing and to prevent them from collapsing during sleep. UPPP helps increase the upper airway by excising the posterior part of the soft palate and uvula and remodeling the anterior and posterior tonsillar pillar. In some cases, complete removal of the tonsils can also be done. Therefore, UPPP enlarges the airway by aiming to change the throat tissue, such as the soft palate, uvula, and tonsils.
Soft Palate - The soft palate is present at the posterior of the roof of the mouth, which is very important for breathing, speaking, and swallowing. Most cases of obstructive sleep apnea are related to airway blockage caused by the soft palate.
Uvula - It is a piece of tissue at the end of the soft palate hanging from the roof of the mouth. This can be one of the reasons for the blockage of the airway. When the uvula gets swollen or enlarged, it can block the airway and most often must be removed by surgery (UPPP).
Tonsils - These are the tissues found on the back of the throat on both sides. These play an essential role in preventing infections. However, larger than normal tonsils can lead to reduced space in the airway, which has to be treated by doing uvulopalatopharyngoplasty.
Why Is This Procedure Performed?
As already mentioned, UPPP is done in mild to moderate obstructive sleep apnea (OSA) cases. However, this is an invasive procedure therefore, in the initial stage of OSA, doctors recommend trying to try making some changes which include -
-
Lifestyle changes such as weight management and changing the sleeping position.
-
Many doctors recommend using nasal expanding strips, CPAP (continuous positive airway pressure), or other oral devices to treat obstructive sleep apnea.
This surgery can also be done in case of severe snoring however, before opting for this surgery, doctors usually recommend the following -
-
Try reducing weight and check if it helps with snoring.
-
Snoring is not a severe condition, and patients should be confident to go for surgery as it does not always work in every case.
In some cases, UPPP is also performed along with other surgical procedures to treat severe forms of OSA.
What Are the Variations of Uvulopalatopharyngoplasty (UPPP)?
Uvulopalatopharyngoplasty is often carried out with other surgical procedures, which usually depend upon the unique anatomy of the individual and the results expected after examining the mouth and airway of the patient. Variations of UPPP include -
1. Tonsillectomy - In this procedure, tonsils are entirely removed, along with reshaping the airway.
2. Adenoidectomy - Adenoids are the tissues located behind the nose at the top of the throat, which helps in preventing upper airway infections. Their surgical removal is called adenoidectomy.
3. Uvulopalatal Flap - In this procedure, the uvula is folded under the soft palate instead of eradicating it.
4. Palatal Advancement Pharyngoplasty - This procedure involves the removal of a portion of the hard palate, which includes two third of the roof of the mouth. By this, the soft palate is moved forward, helping reduce the risk of airway obstruction or collapse.
5. Expansion Sphincter Pharyngoplasty - This procedure aims at strengthening the side walls of the airway by repositioning or removing the tissues within the throat.
6. Relocation Pharyngoplasty - In this surgery, the tissues in the throat are repositioned to create tension on the side of the airway and decrease the chances of collapse.
These newer variations of UPPP help reduce the side effects of the surgery by repositioning or rebuilding the tissues within the throat compared to conducting the UPPP surgery alone.
How Is UPPP Performed?
Before the procedure, some of the following points must be remembered -
The patient should tell the doctor -
-
If they are pregnant or not.
-
Type of drugs or supplements that patient is taking.
-
Habits such as smoking or drinking.
-
The patient is asked to stop taking drugs such as blood thinners before the surgery and only the medications prescribed by the doctors can be taken before the surgery.
Some imaging tests on the head and neck may also to done to check the location of the obstruction and to formulate a plan for surgery. Uvulopalatopharyngoplasty is performed under general anesthesia. Therefore additional tests such as blood tests (complete blood count or CBC), kidney and liver tests, and blood sugar tests might be required. In addition, other tests such as chest X-rays to check the condition of the lungs and ECG (electrocardiogram) to check the heart may also be advised.
What Precautions Should Be Taken After the Surgery?
This surgery usually requires an overnight stay at the hospital, and it takes around two to three weeks to recover completely. After the surgery, the patient may experience the following -
-
The throat will be sore for many weeks, and the patient must take liquid painkillers to ease the pain.
-
The patient is advised to take only soft food and a liquid diet for the first two to three weeks.
-
Avoid hard and crunchy foods that are tough to chew and swallow.
-
Avoid heavy lifting or other strenuous activities.
-
The patient is advised to rinse the mouth after meals with a salt-water solution for the first few days.
With this surgery, sleep apnea starts improving in about 50 percent of the cases. However, with time, the effect of surgery starts wearing off. According to various studies, this surgery is best recommended for people with soft palate abnormalities.
What Are the Possible Complications Related to Uvulopalatopharyngoplasty?
The complications with this surgery are rare, but there are still some chances in some patients experiencing these complications, which include -
-
Bleeding.
-
Reaction to anesthesia.
-
Infection.
-
Nausea or vomiting.
-
Problem in swallowing.
-
Vocal changes.
-
Reduced sense of smell.
-
Formation of scar tissue which may cause blockage in the nose.
Some people do not respond to this surgery. Other methods to control sleep apnea may still be needed.
The chances of complications are higher if a person does -
-
Smoking and drinking.
-
Have chronic diseases such as diabetes.
Conclusion
Uvulopalatoplasty is considered the secondary surgical procedure for treating obstructive sleep apnea if other treatments fail to treat the problem. This is an invasive procedure that is done only in particular cases. The results of this procedure are not that promising, and after a few years, the patient might start experiencing the same problem again, for which other procedures may have to be done along with it.
