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We conducted a retrospective study to evaluate the short-term effect of uvulopalatopharyngoplasty (UPPP) on changes in the nasalance of five vowels: /a/, /ε/, /i/, /Ɔ/, and /u/. Our study group was made up of 20 patients—15 males and 5 females, aged 16 to 57 years (mean: 37.3 ± 11.5)—who had undergone UPPP as a treatment for mild to moderate obstructive sleep apnea. Nasometry was used to obtain nasalance scores in all patients on the morning of the operation (day 1) and subsequently on day 4 or 5 (mean: 4.5 ± 0.5). Preoperatively, nasalance scores were highest for /i/ (mean: 29.8 ± 12.6) and /a/ (mean: 24.1 ± 10.3). After the operation, nasalance scores for all five studied vowels increased; they were highest for /i/ (mean: 40.7 ± +17.8) and /ε/ (mean: 30.0 ± 10.8). The increases in the nasalance of /i/, /ε/, and /u/ were statistically significant (p < 0.05). Our findings indicate that UPPP has a significant impact on nasalance immediately after surgery.

Objective: This study evaluated for increased complications or risk associated with concurrent nasal and oropharyngeal surgeries to treat patients with obstructive sleep apnea (OSA). Study Design: Retrospective chart review. Methods: We performed a retrospective chart review on consecutive patients between 2006 and 2011 who underwent either simultaneous nasal and pharyngeal surgery (group 1) or pharyngeal surgery alone (group 2) to treat OSA. We compared the length of hospitalization and the rate of complications in both groups. Results: Group 1 consisted of 20 patients, all male, with ages ranging from 25 to 72 years (average, 35 years) and apnea-hypopnea index (AHI) from 2.6 to 119 (average, 52.2). Group 2 consisted of 20 patients, 1 female, with ages ranging from 23 to 71 years (average, 37 years) and AHI from 10 to 101 (average, 46.1). In group 1, 30% of patients were ambulatory compared to 25% of patients in group 2. In all cases, the nonambulatory patients were observed for only 1 night. The rate of complications in both groups was 10% (2 out of 20 in each group). Both complications in group 1 were post-tonsillectomy bleeds. In group 2, 1 patient had a post-tonsillectomy bleed and 1 patient was readmitted with dehydration due to poor pain control. There was no statistically significant difference in length of hospitalization or rate of complications in these 2 groups. Conclusion: Performing concurrent nasal and oropharyngeal surgery for OSA was safe when compared to oropharyngeal surgery alone in our cohort and, with careful selection criteria, can even be done in the ambulatory setting. Large, multi-institutional investigations are indicated.

Objectives: This study evaluated the effects of uvulopalatopharyngoplasty (UPPP) on serum leptin levels and endothelial function in patients with obstructive sleep apnea syndrome (OSAS). Methods: Fifteen healthy subjects and 35 patients with moderate to severe OSAS who desired UPPP were prospectively enrolled. The serum levels of leptin and nitric oxide derivative (NOx) from their peripheral blood samples were measured by enzyme-linked immunosorbent assay. All subjects participated in sleep studies, which were repeated 3 months after UPPP in the patients with OSAS. Results: Before UPPP, the patients with OSAS had a higher serum level of leptin and a lower NOx level than did the control subjects. The serum leptin levels in the 17 of the 35 patients with OSAS who were surgical responders decreased from 24.2 ± 6.1 ng/mL before operation to 15.9 ± 6.0 ng/mL after operation. The serum NOx levels in these 17 patients increased from 18.5 ± 7.5 µmol/L before operation to 27.3 ± 8.2 µmol/L after operation. In the 18 patients who were unresponsive to surgery, the serum leptin and NOx levels remained impaired after the UPPP. Conclusions: Successful treatment of OSAS with UPPP leads to the normalization of serum leptin and NOx levels.

We report our experience with hyoid suspension surgery in patients with obstructive sleep apnea (OSA) diagnosed on the basis of polysomnographic criteria. We conducted a prospective, observational study of 20 patients—18 males and 2 females, aged 15 to 52 years (mean: 42. 1)—who were treated at our tertiary care center. All patients underwent hyoid suspension surgery and uvulopalatopharyngoplasty (UPPP) in a single session. Postoperative success was defined as either (1) a reduction in the apnea-hypopnea index (AHI) from 20 or higher to less than 20 or (2) a reduction in AHI of at least 50%. Postoperative follow-up polysomnography indicated that surgery was successful in 18 of 20 patients (90%). No important complications were observed. We conclude that hyoid suspension surgery is an effective procedure with low morbidity for the treatment of OSA in selected patients with hypopharyngeal obstruction. We believe it is a good option for those patients who will not or cannot tolerate therapy with continuous positive airway pressure.

Objectives: To realize better postoperative management in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), we elucidated the need for the postoperative monitoring of esophageal pressure (Pes). Methods: A prospective randomized controlled study was performed. Adult patients with OSAHS were divided into 2 groups: Those administered autoadjusted continuous positive airway pressure (CPAP) before, on, and after the first postoperative night (CPAP group) and those not administered CPAP before or after the surgery (non-CPAP group). Tonsillectomy with uvulopalatopharyngoplasty (UPPP) under general anesthesia was performed on all of the patients. On the first postoperative night, continuous overnight monitoring of Pes and oxygen saturation level was carried out simultaneously with oxygen supplementation in both groups in the patient's room in the general ward. Results: The CPAP group showed a significantly improved mean inspiratory maximal end-apneic Pes swing on the first postoperative night as compared with the non-CPAP group, although there was no significant difference in oxygen desaturation index on the first postoperative night between the 2 groups. Conclusions: Continuous Pes monitoring and CPAP administration were beneficial in the detection and minimization of respiratory disturbances in patients with OSAHS who underwent tonsillectomy with UPPP under general anesthesia.

Objectives: We evaluated the effects of uvulopalatopharyngoplasty (UPPP) on the work of breathing (WOB) in obstructive sleep apnea syndrome (OSAS). Methods: Fifteen healthy subjects and 30 subjects with OSAS who desired UPPP were prospectively enrolled. All underwent measurement of WOB while awake as well as in a sleep study. These studies were repeated 3 months after UPPP in the patients with OSAS. Results: In OSAS before UPPP, the WOB while supine was increased above that of normal subjects. After UPPP, the WOB while supine remained elevated in those whose OSAS did not respond to surgery, and it returned to normal levels in patients whose OSAS improved after UPPP. Conclusions: Abnormal WOB in patients with OSAS returns to normal if UPPP results in amelioration of OSAS.

We conducted a study to determine if the risk of airway compromise following tonsillectomy with uvulopalatopharyngoplasty justifies the added cost and inconvenience of step-down monitoring in an intensive care unit. We performed a retrospective chart review of 130 patients with obstructive sleep apnea who had undergone isolated tonsillectomy with uvulopalatopharyngoplasty at our tertiary care center. The average length of stay in the step-down unit was 18 hours. We found that only eight of these patients (6.2%) had a postoperative desaturation level of less than 90%, including three of 12 patients (25%) who had comorbid conditions. No patient had an adverse respiratory event. We conclude that step-down monitoring in an intensive care unit is not necessary, although caution should be exercised in monitoring patients with comorbidities because they appear to be more prone to desaturation. A complete lack of adverse respiratory events has not been reported in previous studies.

The objective of this study was to investigate the effects on outcomes and morbidity of combining temperature-controlled radiofrequency (TCRF) tongue reduction with uvulopalatopharyngoplasty (UPPP) as an initial site-directed approach to the surgical treatment of obstructive sleep apnea syndrome (OSAS). This investigation was a prospective, nonrandomized, open-enrollment study of 20 consecutive eligible patients with OSAS. Seven patients had a single-level velopharyngeal obstruction (Fujita type I or IIa), and they were assigned to undergo UPPP only (group 1). Thirteen patients had a multilevel velopharyngeal and retroglossal obstruction (Fujita type IIb), and they were assigned to undergo TCRF tongue reduction in addition to UPPP (group 2). Patients who had only a retroglossal obstruction (Fujita type III) were not included in this study. Following their initial operation, nine patients in group 2 underwent two subsequent in-office TCRF tongue treatments under local anesthesia. Three patients in group 2 were lost to followup, and one patient underwent only one TCRF procedure at the initial operation; data on the latter patient are included in some of the outcomes measures reported here where indicated, but no data are reported on the three who were lost to followup. The primary post-treatment outcomes measures were the results of comparative polysomnography and clinician and patient evaluations regarding morbidity and symptom improvement. Analysis of these data showed that there was no difference between the two groups in terms of postoperative pain or dysphagia following the initial operative session. The degree of symptom improvement in the two groups was similar. Overall success rates—as measured by the apnea/hypopnea index (group 1: 57.1% success; group 2: 50.0%) and by the apnea index (group 1: 71.4% success; group 2: 70.0%)—were statistically comparable, given the small size of the sample (figures are based on 10 patients in group 2). The author concludes that combining TCRT tongue reduction with UPPP in patients with multilevel obstruction improves response rates to a degree that is comparable to that seen with UPPP alone in patients with single-level velopharyngeal obstruction. Moreover, the combination treatment does not increase the risk of additional pain, morbidity, and complications compared with UPPP alone.

The objective of this prospective study was to determine the site and pattern of upper airway collapse by a multiple-catheter technique in subjects demonstrated to have obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Standard diagnostic nocturnal polysomnography (PSG) was done on all subjects. The PSG recordings included electroencephalogram, electro-oculogram, electrocardiogram, chin and leg electromyograms, nasal and oral airflow, and abdominal effort. Polysomnography with a multiport flexible airway Gaeltec catheter was performed in 22 subjects. The Gaeltec flexible airway catheter has 4 high-fidelity pressure sensors to aid in determining the primary site of airway collapse. The primary site of airway collapse was determined by differential pressure gradients between pressure ports and by visual inspection of the pressure tracings. Forty-two subjects with prior UPPP from a total of 60 (39 men and 3 women, ages 33 to 61) agreed to be to studied by the standard PSG technique. Thirty-five subjects complained of excessive daytime sleepiness. Ten had mild OSA, 10 had moderate OSA, 12 had severe OSA, and 10 were “normal.” Of the 22 subjects who had airway catheter monitoring, 3 of the normals were reclassified as having upper airway resistance (mean peak negative esophageal pressure of —28 cm H2O); 2 patients demonstrated airway obstruction in the nasopharynx, 2 at the oropharynx, and 11 at the level of the hypopharynx. Postoperative nocturnal PSG data were compared to data gathered prior to UPPP. The mean respiratory disturbance index (RDI) for the catheter group was 54 events per hour prior to UPPP, and the mean RDI after surgery was 44. There was no correlation between the severity of OSA and the stage of sleep. We conclude that the majority of patients who complain of excessive daytime sleepiness following UPPP have OSA with the primary site of obstruction at the level of the hypopharynx. The severity of airway collapse is variable during each stage of sleep. Esophageal pressure monitoring during sleep should be considered when evaluating symptoms of persistent OSA in patients who have had UPPP.

Excessive snoring is a common problem that is frequently treated surgically. In the early 1980s, uvulopalatopharyngoplasty was introduced to the United States as the first surgical treatment for excessive snoring. It remains in common use, but its limitations created an incentive to develop a procedure that is as effective, but safer and more economical. Several other surgical procedures for snoring were developed, including laser-assisted uvulopalatoplasty, palatal stiffening operations, and radiofrequency ablation. Each of these procedures has its own advantages and limitations; which procedure is the best treatment for excessive snoring is controversial. We present our experience with each of these procedures, along with a thorough review of the literature, to help the otolaryngologist determine which is the best snoring surgery for the individual patient.

Uvulopalatopharyngoplasty is, for the most part, both safe and effective as a surgical treatment for obstructive sleep apnea and severe snoring. Strategies for avoidance of complications are discussed and refinements in surgical techniques are presented. Palatal dysfunction is avoided by minimization of shortening of the soft palate in the midline (uvula) area. Nasopharyngeal stenosis is avoided by minimization of posterior pillar resection and avoidance of pharyngeal undermining. Effectiveness of surgery is improved when emphasis is placed on opening the nasopharynx widely in the lateral port areas. Also, tissue removal deep in the inferior tonsillar poles (and hypopharynx) with mucosal advancement and suturing is emphasized.

This investigation assesses the effects of Breathe Right nasal strips on the respiratory disturbance index (RDI) measured by polysomnography in patients suffering from obstructive sleep apnea and snoring. The positive effect of these strips on nasal ventilation was shown in earlier studies. Twenty-six patients with an RDI higher than 10 in an initial measurement underwent a second preoperative polysomnography with Breathe Right nasal strips in place. Nineteen of these 26 patients showed reduction of RDI during the second night of polysomnography using the nasal strips, indicating that nasal obstruction seems to be a predominant factor in the etiology of snoring and apnea in these individuals. Demographic data, medical history, rhinoscopy, clinical assessment of pharyngeal obstruction (Mueller's maneuver), as well as anterior rhinomanometry and acoustic rhinometry were used to identify typical findings correlating with a positive effect of the Breathe Right nasal strips on the RDI: 1. Hyperplasia or hypertrophy of the lower turbinates, septal deviation, and/or allergic rhinitis. 2. None or only minor pharyngeal obstruction. 3. Age less than 55 years. If a positive effect is seen during polysomnography with the strips in place, patients will most likely profit from an improvement of nasal ventilation. This may help to target more effectively septal or turbinate surgery if applicable. In other cases, if a significant RDI reduction is obtained by the use of the nasal strips, they could also offer a noninvasive modality of treatment, especially since the high degree of co-morbidity in this group of patients can sometimes make a surgical approach less favorable.

We retrospectively reviewed the outcomes of 40 patients who had undergone outpatient uvulopalatopharyngoplasty (UPPP) for the treatment of moderate to severe obstructive sleep apnea (OSA) in order to determine the safety of the procedure in an outpatient setting. Postoperatively, 36 of the 40 patients (90%) were discharged home the day of surgery without morbidity; 3 other patients stayed overnight for nonmedical reasons, and 1 patient who was already an inpatient remained hospitalized for unrelated medical issues. No postoperative complications occurred, and all patients reported a resolution of OSA symptoms and improvement in sleep. Based on a combination of our data and those of previous studies, we conclude that patients with significant OSA can safely undergo UPPP as an outpatient procedure. We recommend that guidelines regarding the perioperative care of patients with OSA be adjusted to include consideration of treatment in an outpatient setting.

We present a retrospective analysis of the initial results of our institution's evaluation of a new procedure designed to help relieve snoring, as well as having the potential to assist in the treatment of obstructive sleep apnea. The ambulatory, in-office CO2 laser procedure is performed with a local anesthetic. It is a serial procedure that achieves the same end-result as conventional uvulopalatopharyngoplasty, but without many of the associated problems. The indications for the procedure are reviewed, and detailed technical aspects of its performance, including use of new instrumentation, are discussed. Detailed analysis of the first 20 patients to undergo the procedure in the United States is presented. This is the first series of patients presented in the American literature who have undergone this procedure and who have had long-term follow-up of more than five years. A 90% success rate was achieved. The complication rate, patient tolerance, relative costs, indications and contraindications are discussed.

The files of 585 patients who had had pharyngeal flap surgery for the correction of velopharyngeal insufficiency were reviewed. Eighteen patients, ranging in age from 6 to 16 years, showed clinical symptoms of obstructive sleep apnea syndrome. All of these cases had a Polysomnographic evaluation and videonasopharyngoscopy. Fifteen cases met the criteria for the diagnosis of obstructive sleep apnea syndrome and eventually underwent surgical treatment. A modified uvulopalatopharyngoplasty was done in 14 of the 15 cases. One patient had a prominent uvula flipping into the port of a Jackson's type pharyngoplasty, so a partial resection of the uvula was performed. Surgical treatment was successful in 14 of 15 cases, including the case with the partial uvular resection. In one case, severe sleep apnea persisted after surgery and a complete section of the flap was performed to correct the obstruction. Sizeable tonsils were found in 13 out of 15 cases, whereas flap width appeared unrelated to obstruction. Preoperative assessment of tonsillar tissue is of vital importance before pharyngeal flap surgery.

The success of Uvulopalatopharyngoplasty (UPPP) for Obstructive Sleep Apnea (OSA) can be assessed by a variety of parameters including clinical evaluation and polysomnography (PSG). Patients are often reluctant to undergo post-operative testing and insurance companies are often unwilling to reimburse for expensive overnight sleep studies. Due to the reality of these medical and economical problems, can a clinician be confident of the success of UPPP based solely on clinical evaluation? Sixty patients underwent UPPP for the treatment of OSA from July 1987 through June 1992. Patients treated with tracheostomy or other methods were not included in this study. Fifty-three patients (88%) reported an improvement in their symptoms of snoring, daytime somnolence, morning headache and apnea. Twenty-one patients (35%) had post-operative PSG. Eighteen of 21 patients (85%) reported improvement in their symptoms. Eleven of 21 patients (57%) showed objective improvement in their sleep apnea. The objective findings of PSG do not correlate, in a significant number of patients, with subjective clinical improvement of patients treated with UPPP.

Management of snoring and/or obstructive sleep apnea patients may include uvulopalatopharyngoplasty, a surgical operation that occasionally generates complications. The most serious are perioperative airway problems and palatal dysfunction. Strategies to minimize risks and maximize efficacy are discussed.

Velopharyngeal sonorous snoring is best treated with uvulopalatopharyngoplasty (UPPP). To reduce surgical risks and minimize the morbidity, a simplified carbon dioxide laser uvulopalatoplasty (LUPP) was performed under local anesthesia. Among a total of 146 patients who had a LUPP performed, there was no significant bleeding or postoperative episodes of asphyxia. The procedure was well tolerated even by those patients with strong vomiting reflexes. The operation time was halved, as was the convalescence. Two patients (1.4%) developed scarring with nasal obstruction, but the impact of factors other than the laser approach itself seemed to be the cause. By scored questionnaires the effect on snoring, family complaints, and daytime somnolence was evaluated in two comparable random groups of patients. Sixty-three patients had LUPP procedures, and 37 had UPPP. The short-term results showed that about 90% of the patients considered themselves essentially improved as regarded snoring and that most patients felt more alert, irrespective of the surgical method used.

Uvulopalatopharyngoplasty is widely used to treat obstructive sleep apnea, and many techniques are described in the literature. However, complications and failures remain a problem. We describe a new imbrication technique that reduces pain, minimizes bleeding, and serves to realign muscle tension, thereby reducing palatal bulk. The imbrication technique has become the standard procedure at our clinic.

We report the case of an adult who developed an isolated-solitary papilloma on the margin of the soft palate 1 month after he had undergone a uvulopalatopharyngoplasty. We describe the clinical and cellular characteristics of this common lesion.

Acute hypercapnic respiratory failure is a rare but life-threatening complication in grossly obese patients with severe obstructive sleep apnoea (OSA). Facial trauma or upper airway surgery, respiratory tract infections, bronchospasm, use of pain medication and concomitant obstructive or restrictive pulmonary impairment predispose to the development of respiratory failure in such patients. We present a case of a morbidly obese male patient in whom moderately severe OSA (the apnoea-hypoponea index, AHI of 37/hour) was treated with uvulapalatopharyngoplasty (UPPP) because he declined treatment with non-invasive ventilation. The early postoperative period was complicated by severe hypercapnic respiratory failure in association with worsening of OSA: arterial PO2 was 4.14 kPa, PCO2 9.7 kPa, AHI increased to 93.8/hour, minimal nocturnal arterial oxygen saturation was 46%. Therapy with non-invasive ventilation using bi-level positive airway pressure (BiPAP) was initiated immediately, and resulted in marked improvements in the patient's clinical condition, in association with the improvements in arterial blood gases. Before the discharge, nocturnal continuous positive airway pressure (CPAP) therapy to treat OSA on the long-term basis was initiated. Two months after the release, the patient's blood gases were within the normal range, and he reported marked improvements in his clinical condition including alleviation of daytime sleepiness and increased physical endurance. Our case demonstrates that in the presence of severe OSA, life-threatening hypoxaemia and hypercapnia were successfully alleviated using BiPAP in the postoperative period after UPPP.

The experience of the uvulopalatopharyngoplasty operation, performed on 24 patients for the relief of loud or heroic snoring, is presented. The operation successfully reduced the severity of snoring in 96% of patients. Postoperative complications were uncommon but included nasal regurgitation and intrapharyngeal adhesions in one patient. The role of the uvulopalatopharyngoplasty operation in the treatment of obstructive sleep apnoea is undecided but the authors do not perform this operation on such patients.

Uvulopalatopharyngoplasty (UPPP) is currently the preferred method for treatment of the obstructive sleep apnea syndrome (OSAS). However, only 50 per cent of the patients operated upon are cured by this surgical procedure, and there is a demand for better and more objective selection criteria. Computed tomography (CT) of the oropharynx was obtained in 32 consecutive adult patients with proven OSAS. An additional 15 patients with the same complaints, but without objective evidence of OSAS, were used as a control group, together with 20 normal subjects. The axial widths of the tongue and the genioglossus and hyoglossus muscles were measured by CT. Both the tongue and genioglossus widths were significantly larger in the OSAS patients than in the two control groups (p