Uvulopalatopharyngoplasty (UPPP) Operation - Sleep Apnea and Snoring Surgery

UPPP - Sleep Apnea Surgery

Uvulopalatopharyngoplasty (UPPP) Operation in Istanbul

Image description: Snoring, difficulty breathing while sleeping on his back, sleep apnea (sleep apnea), night sweating, tired waking and tiredness during the day of the patient's complaints in the examination of the large tonsil structure and closed airway on the left. Tonsillectomy + soft palate resection + uvulectomy surgery (uvulupalatopharyngoplasty - UPPP) shows the state after (see photo on the right).

Uvulopalatopharyngoplasty (UPPP) Operation Definition

The most common surgical procedures performed in patients with sleep apnea are soft palate operations. The purpose of soft palate surgery is to reduce the volume of small tongue (uvula), soft palate and tonsils (tonsils) and to expand and stretch the airway behind the soft palate. In the initial period, different surgical techniques have been defined according to the anatomical structure of the patient and the content of the problem over time considering the difficulties and disadvantages of classical palate operations called uvulopharyngopalatoplasty (UPPP).

What is The Uvulopalatopharyngoplasty (UPPP)?

UPPP is an operation performed to reduce tonsil, soft palate and uvula volume in people with sleep apnea. Snoring is caused by the loss of large tonsils or uvula and / or soft palate tension. Uvulopalatopharyngoplasty (UPPP) was first described by Fujita et al. In 1981 and has been accepted as the main basic technique in the surgical treatment of obstructive sleep apnea syndrome (OSAS). Since the first description of this technique, the effectiveness of the method in the treatment of sleep apnea has been investigated. Unfortunately, the results of these studies have shown that the efficacy of UPPP alone is limited. UPPP alone has a limited success rate in the treatment of patients with sleep apnea. In contrast, in carefully selected patients, the success rate increases when palatal procedures are combined with other surgical methods for upper airway obstruction sites.

OSAS is characterized by a complete or partial airway obstruction that causes periodic intermittent respiratory arrest (apnea) during sleep or a reduction in airflow (hypopnea) despite respiratory effort. UPPP is the most common method, although there is no other surgical method that provides definite OSAS treatment except tracheotomy. The aim of OSAS treatment is to reduce symptoms by reducing mortality and morbidity with minimal side effects. Over the last 20 years, several surgical procedures have been described for the treatment of OSAS.

Uvulopalatopharyngoplasty Technical Details

The first surgical intervention in OSAS is UPPP. First described by Ikematsu 6 in 1964, this initiative was later modified in 1981 by Fujita et al. UPPP resolves the entire uvula, a portion of the distal part of the soft palate, the palatinal tonsils, and the excess mucosa in the anterior and posterior tonsillar plicas. The ideal resection limit in the soft palate is the level of the dimple point that occurs when the soft palate is pulled forward by holding the tip of the uvula or one finger down the distal edge of the hard palate. After tonsillectomy, excessive mucosa in the posterior plicas are resected, the mucosa on the lingual face of the uvula, submucosa and gland and fatty tissue are excised. Bipolar cautery bleeding control after uvula backward; is folded to the soft palate. In the photo above, uvula resection was performed. In general, our unit can be processed using "Thermal Welding Device" which reduces bloodless and mucous membrane damage.

An effective surgical method in snoring and sleep Apnea: tonsillectomy, palate Stretching and uvula surgery

Uvulopalatopharyngoplasty (UPPP) Operation - Sleep Apnea and Snoring Surgery in Istanbul

In patients with sleep apnea syndrome and snoring, there is an effective snoring operation for large tonsils, sagging soft palates and uvula elongation. As seen in the photographs, the airway opening of the patients with postoperative closed airway is seen. This surgical procedure is called Uvulopalatopharyngoplasty (UPPP). Almond surgery, small tongue surgery and palate stretching are performed at the same time. The aim is to remove the tissues that cover the airway and to stiffen the palate region that is loose and suitable for closure. These 3 processes can be modified in different ways.

Uvulopalatopharyngoplasty Contraindications

The use of UPPP is contraindicated in patients who are at risk of talking with velopharyngeal insufficiency, submucous cleft palate and swallowing, and in patients with collapsed region not at the upper pharyngeal level. Apart from these, there are health problems that prevent general anesthesia, bleeding disorders and active tonsil infection.

Complications of Uvulopalatopharyngoplasty

The most common complication that the patients frequently complain of is postoperative pain. In acute rotation, bleeding may occur in patients who cannot drink enough water from the mouth and in patients with dry throat. Long-term complications include difficulty swallowing, dry mouth, runny nasal discharge, and a feeling of tension.

Patient Selection For UPPP

Uvulopalatopharyngoplasty (UPPP) operation is a procedure consisting of roughly 3 separate surgeries defined especially for patients with tonsillar hypertrophy, sagging soft palate and elonge uvula. Patients with obstruction of the lower and upper parts of the oropharyngeal region (eg patients with retrolingual air) are not suitable candidates for this operation.

Postoperative Healing and Care For UPPP

The most common and frequently complained problem is postoperative pain. Although it gradually decreases after surgery, pain is observed especially in the first 5-7 days. Dry mouth which may be the cause of complaints in the long term, the feeling of stretching in the throat and nasal discharge is caused by the inability of the small tongue (uvula) to function.

Postoperatively, the dissolvable stitches in the soft palate usually disappears completely within 2-4 weeks. Patients need to drink water intermittently in order to achieve the fastest recovery after surgery. In patients who drink small amounts of water due to pain, the amount of pain sensed may increase and a "vicious circle" may occur. Please drink plenty of water!

Likewise, it is important to choose foods with high water content. After the UPPP surgery, it is inconvenient to consume hot, spicy, particulate, salty foods with sharp edges. Be patient for the first 10 days, and then you can see that the pain is getting pretty low.

Exercise after UPPP operation

You can walk for the first week after the UPPP surgery and it may be appropriate to carry water during your walk and drink less and frequent water. You can start heavy exercise and sport activities in a few weeks.

Cost of Uvulopalatopharyngoplasty (UPPP) 

Total UPPP operaton cost in Istanbul (1 day hospital stay, including all material and blood tests), UPPP operation with Thermal Welding Device varies between 3000 and 4500 US Dollars.

Sleep Apnea and Holama Can Not Always Be Treated Easily!

Sleep apnea and snoring are usually associated with narrowing of the upper respiratory tract. In particular, constriction areas in the upper respiratory tract may not always be treated by surgical intervention. In patients with obesity and inadequate physical activity, airway obstruction areas are more than one and in the foreground, increasing physical activity, calorie restriction and weight loss are effective in the treatment.

Obstructive sleep apnea syndrome (OSAS) is detected in 2-4% of the general population. It is associated with problems such as daytime sleepiness, snoring and cardiovascular complications. Obstructions are common or limited to the retrolingual and / or retropalatal level. The success rate of palatal surgery is high in patients with obstruction only in the retropalatal region. Palatal surgeries are more successful in carefully selected patients when combined with other surgical procedures for multiple obstruction sites in the upper airway.

Nowadays, classical UPPP surgery is preferred less frequently with soft palate tissues and uvula completely removed!

Nowadays, classical UPPP surgery, where soft palate tissues and uvulna are completely removed, is preferred less and the surgical technique is decided according to the content of the problem after evaluation with sleep endoscopy.

Similar links >> Tonsillectomy Operation in Istanbul / Enlarged Tonsils and Sleep Apnea, Fatigue, Hearth Problems

Source link >> Uvulopalatopharyngoplasty - an overview

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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