A Simple Partial Uvulectomy Technique Under Local Anesthesia For The Treatment of Uvula Papilloma: Clamping and Knotting

Viral Papilloma (Wart) at The Tip of the Uvula and Simple Excision

Oral Papillomas (Warts),Uvulectomy, Papilloma of Uvula, Partial uvulectomy, Human Papillomavirus,oral HPV infection,
The incidence of Human Papillomavirus (HPV) oral infection is quite common, and sometimes coincidental warts can be seen on the tip of the uvula, which may cause a cough or a feeling of stuck in the throat. A 45-year-old female patient with a mass lesion that gradually increases in size at the tip of the uvula and causes a feeling of stuck in the throat, was found to have a painless, rough-surfaced lesion at the tip of the uvula, consistent with a papilloma. Partial uvulectomy operation was performed on the patient under local anesthesia in office conditions. As a result of histopathological examination, koilocytic changes and viral papilloma were diagnosed.  Similar scientific article, case report that we have published before >> >> Pedicled Mucosal Flap of the Uvula: An Unusual Cause of Chronic Cough in an Adult

Surgical technique of simple uvulectomy operation (uvulectomy operation with simple clamping and knotting technique in office conditions)

What I share with you here includes a simple resection of the tip of the uvula (partial uvulectomy) in office conditions. First of all, in order for this procedure to be performed under local anesthesia, the patient must be compliant and the gag reflex must not be too much (no hyperreflexia). The process can be done in the following order:

- Oral spray containing lidocaine is sprayed
- Local anesthetic containing lidocaine and adrenaline is injected into the junction of the uvula with the soft palate
- The clamp is placed over the incision area.
- Self-absorbable 3/0 vicryl suture material is applied on the clamp.
- The lower part of the uvula is cut with scissors under the clamp.

Here, the tie knot should be a few mm above the incision. If the incision is made just under the suture, it may slip and cause the suture material to fall.

Before The Operation

Papilloma of The Uvula

Papilloma of The Uvula

Papilloma of The Uvula

Image description: In the 3 photos above, a lesion consistent with a papilloma is seen just at the tip of the uvula. The patient states that he contacts the base of the tongue and the pharynx during swallowing.

Just After Partial Uvulectomy

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Image description: In the 4 photos above, it is seen just after partial uvulectomy in office conditions. During the injection of local anesthetic, redness and edema at the root of the uvula are seen due to the blood soaking under the mucous membrane.

Excised Biopsy Material

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

1 Day After Partial Uvulectomy

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Image description: In the 2 photos above, one day after the partial uvulectomy, the part under the knot turns white.

2 Days After Partial Uvulectomy

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Image description: In the photo above, two days after the partial uvulectomy, the part under the knot is whitened, the remaining part of the uvula is swollen and slightly hyperemic.

4 Days After Partial Uvulectomy

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Image description: In the photo above, 4 days after the partial uvulectomy, it is seen that the part under the knot is white and about to fall off, the swelling and redness of the remaining part of the uvula has decreased.

5 Days After Partial Uvulectomy

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Image description: In the photo above, 5 days after the partial uvulectomy, it is seen that the part under the knot has fallen away and the swelling and redness of the remaining part of the uvula have decreased considerably.

6 Days After Partial Uvulectomy

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Image description: In the two photos above, 6 days after the partial uvulectomy, only a small amount of white is visible on the remaining part of the uvula, at the incision area.

7 Days After Partial Uvulectomy

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

Image description: In the photo above, 7 days after the partial uvulectomy, only a small amount of white is visible on the remaining part of the uvula at the incision area, which is barely visible. The recovery seems almost complete :)

An annual endoscopic examination and follow-up were planned for the patient, a wide panel, HPV DNA screening test was requested from mouthwash. For genital examination, gynecological examination and follow-up were recommended to a gynecologist for examination.

Advantages and disadvantages of simple clamp-assisted partial uvulectomy

Advantages of this process:

- can be done in office conditions
- Since cautery or laser is not used, there is no heat damage to the mucosa, the recovery rate is shorter after the procedure and the amount of pain felt is very low.

Disadvantages of this process:

- It is not suitable for patients with very pronounced gag reflexes and cannot be applied to all patients.
- The suture material placed on the forehead of the uvula falls off with a small amount of uvula tissue after a few days. Although the risk of aspiration is very low, it can be found.

8 Days After Partial Uvulectomy

Oral Papillomas (Warts),uvulectomy,Papilloma of Uvula,oral HPV infection,Human Papillomavirus,Partial uvulectomy,

It is seen that the recovery is almost complete on the 8th day after partial uvulectomy. Unlike other procedures such as electrocautery and laser that cause mucosal damage, the healing was completed in such a short time due to the lesser mucosal trauma.



Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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E-Mail: muratenoz@gmail.com 
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Comments

  1. What a guide, I must say, your guides are awesome and I enjoy reading them. You write to the point and with a clear and eye-catchy UI, your blog looks great.
    I have bookmarked your website, keep posting articles like this.
    Thanks!

    ReplyDelete
    Replies
    1. Thanks for your kind words and interest with my website. My pleasure to share this content.
      Greetings from istanbul,
      Assoc.Prof.Dr.Murat Enoz

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