Many surgical procedures for obstructive sleep apnea (OSA) and loud snoring are offered, but uvulopalatopharyngoplasty (UPPP) is the most popular operation to restore your normal breathing and stop your snoring.
While loud snoring is a glaring symptom, obstructive sleep apnea is diagnosed through a sleep study called polysomnography.
Central sleep apnea (CSA) is not an indication of surgery. The third type of sleep apnea called complex sleep apnea has the presence of both OSA and CSA. This presents a challenge to the surgeon who then takes a call after examining the case individually.
UPPP Surgery Procedure
UPPP is performed in a hospital under general anesthesia and involves the removal of soft tissues in your throat that could be interfering with your airway and breathing.
Patients with OSA have an excessive amount of loose sagging tissue in the oropharynx area that blocks the airway during sleep and is one of the main causes of snoring. Such structures are removed in this surgery.
Other structures could be the nasal septum, nasal turbinates, adenoids, tonsils, tonsillar pillars, uvula, soft palate, and base of the tongue. Craniofacial abnormalities, if present, are corrected through surgery.
Removal of the obstructing structure clears your airways. This restores normal breathing and stops snoring. UPPP is also referred to as a snoring operation or snoring surgery in layman’s terms.
UPPP success rate and recovery
However, the effectiveness of this surgery is still in question and this surgery is not always successful especially if there are other tissues lower down the throat, which could be obstructing your airway passage.
You may, therefore, still require to use continuous positive air pressure (CPAP) equipment after this surgery. UPPP is successful only in 50% of sleep apnea cases.
UPPP is often effective in reducing snoring in the beginning. Over the long term, it cures snoring in 46% to 73% of people.
In children, usually, UPPP is not required. Only the removal of the tonsils and the adenoids solves the problem.
Indications for UPPP
UPPP is usually indicated in obstructive sleep apnea (OSA) when
- the cause that can be surgically corrected is present and where the patient has tried CPAP without success.
- the soft tissues in your throat obstruct the airway and interfere with your breathing.
- loud snoring is present
- you have refused the use of CPAP because of discomfort
Contraindications
The submucous cleft palate (SMCP) is a type of cleft palate that may cause velopharyngeal insufficiency (VPI). UPPP is contraindicated in people with this condition.
In velopalatal insufficiency, the liquids that you swallow may enter the nose. The palate in normal cases prevents this and if too much of it is resected, this complication can arise.
Complications
The surgery procedure has undergone modifications now to prevent or minimize some long-term complications that may include:
- Swallowing difficulties,
- The feeling of a foreign body stuck in the throat,
- Narrowing of the airway due to scarring caused by the surgery,
- Apnea and daytime sleepiness if you take painkillers or sleeping pills,
- Swelling, pain, or infection at the site of operation,
- Change in voice such as you may acquire a nasal quality in your voice.
New LAUP for Sleep Apnea
Nowadays, laser-assisted uvulopalatoplasty (LAUP) is also being done to reduce snoring. In this surgery, less tissue is removed as compared to UPPP and this surgery can also be performed in the physician’s office. However, the success rate is less than 50% and there is not enough evidence to show that LAUP controls apnea at all.
Post-operative care
The patient is discharged after one night’s stay in the hospital. He is advised to sleep in a recliner for the first two nights and use a CPAP device. He should report in case of any discomfort or complaint.
The patient will be put on narcotic pain medication after surgery for 7 to 14 days. Due to pain and difficulty in swallowing, he will be on a liquid and soft diet for a few days post-surgery.
It takes about three weeks to completely recover from surgery. Follow-up polysomnography is advised after six months.
