Uvulopalatopharyngoplasty (also known by the abbreviation UPPP) is a procedure used to decrease or remove the sound of snoring in human beings during sleep. The procedure involves removing excess tissue in the throat, widening the airway. More air is then able to pass through the airway, and snoring is usually decreased.

The procedure is used to "cure" snoring for the benefit of other people who are affected by the loud snoring of the patient. Loud snoring can cause loss of sleep in those that hear it. This procedure is also used to treat obstructive sleep apnea.

The throat tissue removed in the surgery may or may not include:

• The uvula (see uvulotomy)
• The soft palate.
• Excess throat tissue, tonsils and adenoids, and the pharynx.

The procedure can be very painful for up to 10 days afterwards with over 60% of past patients refusing to consider further UPPP surgery.

Success

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Due to the other causes of snoring such as restrictions to the nasal cavity, levels of obesity and the variations in removed tissue, there are limited studies of UPPP as an isolated procedure. Although in the short-term the snoring can be improved or eliminated, unless the surgery is followed by treatment of other potential causes, within two years the procedure remains effective in less than 40% of patients. There is little data about the long term effectiveness, but it is likely to be even less. Patients undergoing UPPP should always be selected relying on otolaryngologic examination including flexible nasopharyngoscopy, cephalometry and on polysomnography. UPPP effectiveness depends on rational selection of candidates

LAUP (laser-assisted uvulopalatopharyngoplasty)

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The laser variation of this procedure, "laser-assisted uvulopalatopharyngoplasty" (or LAUP) is even more controversial. It was aggressively marketed as a so-called "cure" for snoring during the late 1980s and early 1990s. It was first pioneered by Kamami, a Japanese surgeon, who had used the procedure mostly on Japanese females who were of slender build. Early results seemed favourable, but during the late 1990s, researchers (including Finkelstein, Schmidt and others published data which showed that in a considerable number of patients, 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 the thermal damage inflicted by the laser beam. The laser may induce progressive palatal fibrosis, accompanied with medial traction of the posterior tonsillar pillars. In plain English, this means that the laser beam can create a lot of scar tissue, which can reduce the airspace in the pharnyx and lead to a condition known as velo-pharnygeal 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 post-operative polysomnogram (sleep testing) or follow-up. An LAUP procedure typically sells for between two and three thousand American dollars. The procedure takes roughly thirty minutes and is usually done in a surgeons office as an out-patient procedure. Typically a CO2 type laser is used.

Risks

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During surgery, there is a risk of damaging surrounding blood vessels or tissue around the throat.

After surgery, complications may include:

• Sleepiness and sleep apnea related to post-surgery medication
• Swelling, infection and bleeding
• A sore throat and/or difficulty swallowing
• Drainage of secretions into the nose and a nasal quality to the voice. Speech does not seem to be affected with this surgery
• Narrowing of the airway in the nose and throat (hence constricting breathing, snoring and even iatrogenically caused sleep apnea.

References

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• WebMDHealth. Uvulopalatopharyngoplasty for snoring Retrieved August 26 2005.
• Royal College of Surgeons Audit Symposium March 8th 2002 Retrieved April 22 2006.
• University of Maryland Medical Center Patient Education - UPPP Retrieved April 22 2006.
• The Vancouver Sleep and Breathing Centre May 30 2006 Risks associated with LAUP surgeries