To use all functions of this page, please activate cookies in your browser.
With an accout for my.bionity.com you can always see everything at a glance – and you can configure your own website and individual newsletter.
- My watch list
- My saved searches
- My saved topics
- My newsletter
Uvulopalatopharyngoplasty (also known by the abbreviations UPPP and UP3) is a surgical procedure used to remove tissue in the throat. It involves the removal of tissues which may or may not include:
Additional recommended knowledge
How UPPP is Administered
Patients undergo the UPPP operation in two very different ways, with the majority of patients receiving UPPP as a stand-alone procedure. Other patients undergo UPPP as the first procedure in a stepped plan known as "The Stanford Protocol Operation". The way in which UPPP is administered greatly affects the overall prognosis of the intervention.
Standard UPPP (The operation as a stand-alone surgical intervention)
The Role of UPPP in the "Stanford Protocol" Operation
The Protocol operation involves two phases. First, the patient undergoes soft tissue surgeries, UPPP along with Genioglossus Advancement or Hyoid Suspension. After the first phase, the patient is given a sleep study and reassessed. The vast majority of patients fail the first phase, and the course of treatment may then proceed to Phase Two.
Phase Two involves maxillomandibular advancement, a surgery which moves the jaw top (maxilla) and bottom (mandible) forward. The tongue muscle is anchored to the chin, and translation of the mandible forward pulls the tongue forward as well. If the procedure achieves the desired results, when the patient sleeps and the tongue relaxes, it will no longer be able to block the airway. Success is much better for Phase two than for Phase One- approximately 90 percent benefit from the second phase, and the success of the Stanford Protocol Operation therefore is due in large part to this second phase.
Because of its high rate of complications, the role of UPPP in the Stanford Protocol operation is an important consideration that surgeons must weigh. Some surgeons, including Doctors Powell and Riley, feel that UPPP contributes to the overall success of the Stanford Protocol operation. This assertion is open to debate. In 2002, an Atlanta based surgical team, led by Dr. Jeffrey Prinsell, published results which have approximated those of the Stanford team when UPPP was not included in their mix of surgeries.
The Effectiveness of UPPP in Isolation
Effectiveness of "The Stanford Protocol" Operation
Laser-assisted uvulopalatopharyngoplasty (LAUP) became popular during the 1980s when it was aggressively marketed as a so-called "cure" for snoring. It was first emloyed by Yves Victor Kamami, a surgeon of the Marie-Louise Clinic in Paris, France, on people who were of slender build. Early results seemed favourable, and studies of flawed methodology were published. Longterm follow-up information was omitted entirely. The practice of using lasers to address snoring became widespread. During the late 1990s, researchers (including Finkelstein, Schmidt and others) published data which demonstrated that in a considerable number of cases, laser-assisted uvulopalatoplasty may also cause mild OSA in patients who formerly were nonapneic snorers, or lead to deterioration of existing apnea. These results are attributable to thermal damage inflicted by the laser beam. The laser may induce progressive palatal fibrosis, accompanied by medial traction of the posterior tonsillar pillars ie., scar tissue reduces the airspace in the pharynx leading to velopharyngeal insufficiency. The scar tissue can also make the airway more prone to collapse during sleep. LAUP can be a medically induced cause of sleep apnea. Despite adverse results, LAUP continues to be administered by a minority of surgeons. To this day, few if any patients who have undergone laser-assisted uvulopalatopharyngoplasty for primary (social) snoring have been provided with pre- and postoperative polysomnogram (sleep testing) or followup. An LAUP procedure typically costs between two and three thousand American dollars. It takes roughly thirty minutes and is usually done in a surgeon's office as an outpatient procedure. Typically a CO2 type laser is used.
One of the risks is that by cutting the tissues, excess scar tissue can "tighten" the airway and make it even smaller than it was before UPPP. Some individuals who have undergone UPPP as a stand alone procedure have written on internet forums that they experienced a worsening of their breathing following UPPP. Others have spoken of severe acid reflux.
After surgery, complications may include:
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Uvulopalatopharyngoplasty". A list of authors is available in Wikipedia.|