Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) is a surgical procedure for the treatment of severe Obstructive Sleep Apnea. Sleep Apnea is a common medical disorder causing daytime sleepiness and impaired daytime working performance in around 1 in 50 adults.

These symptoms are due to the throat narrowing or blocking repeatedly during sleep.  This causes an apnea - a medical term for a breathing suspension - and subsequent sleep disturbance.

The patients usually find nocturnal sleep unrefreshing and their partners may observe loud snoring with intermittent breathing pauses.

Recurrent narrowing or blockage of the throat causes Sleep Apnea during sleep.  The throat is normally held open by muscles, but these relax during sleep and thus there is a tendency in everyone for the throat to be sucked narrow when air is sucked in during breathing when asleep.

If the throat blocks, the person tries to fight for breath until they eventually waken themselves up - so briefly that they remember nothing about it in the morning. In general, patients with the Sleep Apnea should try to lose weight, where applicable. 

They should also avoid evening alcohol and any sedatives or sleeping pills as both of these will inhibit upper airway muscle function and predispose to blockage of the throat.

Uvulopalatopharyngoplasty (UPPP) is an operation to recover certain sleep disorder symptoms such as obstructive sleep apnea and snoring. The operation involves the removal of the uvula and back of the soft palate, often accompanied by tonsillectomy.

UPPP is considered as an alternative for the treatment of Sleep Apnea only after the failure of CPAP devices (continuous positive airway pressure) to cure the condition.

In UPPP, soft tissue on the back of the throat and soft palate (the uvula) is removed.

The tonsils and possibly other excess tissue may also be removed, if present. The process increases the width of the airway at the throat opening, improves the opening ability by interrupting muscular action, and “squares off” the palate to enhance its movement and closure. UPPP does not address apnea or snoring caused by obstructions at the base of tongue.

Surgeons usually use either conventional scalpel techniques or newer laser methods (LAUP, or Laser-Assisted Uvulopalatoplasty). LAUP may have a higher rate of success than UPPP, but it also requires the expertise of a surgeon highly skilled in laser procedures.

Either way, UPPP generally requires three to five separate treatments, as only a small amount of tissue may be removed at a time. UPPP is an invasive procedure that typically requires general anesthesia and an overnight hospital stay.

Adverse effects of UPPP include:

• Bleeding
• Pain
• Risk of infection
• Decreased efficacy of CPAP after UPPP
• Changes in voice frequency

Treating Snoring

Uvulopalatopharyngoplasty is sometimes used to treat snoring in people so that their bed partner can sleep better. It is seldom used and only considered in cases of very severe snoring when other treatments have failed. It may be used in people:

• With excess tissue in the nose, mouth, or throat that blocks their airway.
• Who do not stop snoring after making lifestyle changes such as losing weight and sleeping on their side.

UPPP Surgery Overview

Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue in the throat, which widens the airway. This sometimes can allow air to move through the throat more easily when you breathe, decreasing snoring.

The tissues removed may include:

• The small fingerlike piece of tissue that hangs down from the back of the roof of the mouth into the throat (uvula).
• Excess throat tissue, tonsils and adenoids, and the pharynx.
• Part of the roof of the mouth (soft palate).

It takes about 3 weeks to improve from surgery. It may be very difficult to swallow after surgery and because of this, only 60% of those having the surgery say they would undergo it again.

Uvulopalatopharyngoplasty Complications

Complications during surgery include unintentional damage to surrounding blood vessels or tissues.

Complications after surgery may include:

• Swelling, pain, infection, and bleeding.
• Sleepiness and periods of not breathing (apnea) related to the medications used to put you to sleep.
• A sore throat and difficulty swallowing.
• Narrowing of the airway in the nose and throat.
• Drainage of secretions into the nose and a nasal quality to the voice. Speech does not seem to be affected with this surgery.