Surgery

¨Uvulopalatopharyngoplasty (UPPP, UP3)

Designed to enlarge a patients Pharynx by removing the uvula, tonsils and part of the soft palate.

¨Enlarges the throat by removing tonsils, uvula and edge of soft palate.

¨Should be considered after more conservative methods of treatment have failed.

Laser assisted Uvulopalatoplasty (LAUP)

Performed under local anesthetic, may require multiple treatments.

Quick and Safe.

May require multiple treatments.

Removes excess uvular and soft tissues while simultaneously firming these structures.

Should be considered when more conservative treatments have failed.

¨UP3 and LAUP surgery involves removal of the Uvula.

Other Surgeries

Nasal Septoplasty
Nasal Polypectomy

Adenoidectomy

Tonsillectomy etc.

All designed to improve air passage through the upper airway.

20% Relapse Rate In Successful Surgeries

25-40% Success Rate For OSA (Better for Snoring)

ORAL APPLIANCES POST UP3 SURGERY

(Millman et al. CHEST April 1998)

¨24 failed UPPP OSA patients.

¨An adjustable Herbst Appliance was constructed for them post surgery.

¨6 patients dropped out of the appliance study.

¨Base line prior to surgery: AHI = 42.3, SaO2 = 83.6%

¨After UPPP surgery there was no significant change in AHI

¨After adjustable oral appliance was provided for patient: AHI = 15.3, SaO2 = 87.9%. Post appliance insertion ten 11 of 12 patients felt that their subjective daytime sleepiness resolved.

In 1994 the American Academy of Sleep Medicine stated;

“Because adequate peer-reviewed objective data do not exist regarding the effectiveness of LAUP for the treatment of sleep-related breathing disorders, including OSA, LAUP is not recommended for the treatment of these disorders”.

Current literature is overflowing with evidence that the LAUP procedure is a poor treatment alternative for the treatment of patients with breathing related sleep disorders. In an article entitled “Uvulopalatopharyngoplasty VS Laser-Assisted Uvuloplasty” penned by Finkelstein et al. in 1997, it was concluded:

“From an anatomical viewpoint, laser-assisted surgery of the palate is significantly inferior to conventional uvulopalatopharyngoplasty and may even be deleterious. The results of preoperative and postoperative polysomnographic comparisons in patients who undergo laser-assisted operations should be evaluated to determine whether future laser-assisted surgery is an adequate option, even for snoring as an isolated symptom”

In another article entitled “technologic Advances in the Treatment of Obstructive Sleep Apnea Syndrome” penned by Dr. Daniel Loube in 1999 he draws the following conclusion regarding Palatal Surgery;

“In summary, palatal procedures alone are not likely to be effective for the majority of OSAS patients, no matter which technique is used. To date, no studies guide the selection of patients more likely to benefit from these procedures, except possibly for those with mild severity based on AHI. As discussed below, it is necessary that additional surgical procedures be available to allow the salvaging of palatal surgical failures.”

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Last modified: October 17, 2007