Uvulopharyngopalatoplasty

What is Uvulopharyngopalatoplasty (UPPP)?

Uvulopharyngopalatoplasty is the surgical procedure to remove the uvula and some of the surrounding tissue in the back of the throat.

The procedure is performed for treatment of snoring and obstructive sleep apnea. The operation changes the shape of the pharynx removing soft tissue from the pharynx which is obstructing the airway and hence preventing good airflow during breathing.

UPPP

Indications for operation

The operation of UPPP is for the treatment of snoring and obstructive sleep apnea.

The operation changes the shape of the pharynx removing soft tissue from the pharynx which is obstructing the airway and hence preventing good airflow during breathing.

Snoring occurs at three levels.. Firstly the nose, secondly the throat and thirdly the body shape and size. This pamphlet describes treatment to the second level of obstruction and this is the pharynx. Snoring occurs when the side walls of the pharynx is sucked inwards and the uvula (dangly midline end of the palate), vibrates as air passes over the surface producing the snoring sound. The uvula normally functions as a door that closes when we swallow, preventing food and drink passing out of the nose. The uvula itself however, can be quite enlarged in some people and like a swinging door banging in the breeze, makes a noise. Snoring occurs when sleeping, as is during this time that there is a reduction in muscle tone, allowing redundant tissue to be sucked closer together and vibrate.

In a condition called Obstructive Sleep Apnea, no airflow occurs and patients stop breathing, sometimes over 30 second durations. Patients with sleep apnea have reduced oxygen in their blood and this causes many medical conditions, such as high blood pressure, increased risk of heart attack and stroke. Patients with sleep apnea have poor sleep and often feel unrefreshed in the morning, with daytime tiredness. If sleep apnea is present, then a sleep study is generally performed prior to an operative procedure of this type.

The UPPP operation is extremely successful in excess of 90% in reducing snoring to an acceptable level. The results of curing sleep apnea are reduced to approximately 60%. The procedure is therefore primarily a snoring prevention procedure.

The Surgery

The surgery is performed under a general anesthetic with overnight stay in hospital. Mr Watson generally removes the tonsils using a diathermy technique. This cauterizes the tissue, and therefore prevents active bleeding. If the tonsils have previously been removed, then there may be some excision of soft tissue in this region to remove redundant tissue. The uvula and end of the palate is removed and the tissues of the palate stitched with an absorbable stitch material, in order to create a square shape of the palate. This squaring and shortening of the palate prevents vibration and hence the creation of sound.

Patients, after procedure return to the ward, but those patients with obstructive sleep apnea are generally nursed in a high dependency unit.