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You're not the only one…According to H. Dugan’s “Bedlam in the Boudour” (1947): “Twenty of thirty-two Presidents of the Unitied States are proved or believed on a thick web of circumstances to have been nocturnal nuisances in the White House” and “President Theodore Roosevelt once snored so loudly in a hospital that complaints were filed by almost every patient in the wing where he was recuperating”
Uvulopalatopharyngoplasty (UPPP) Print E-mail
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Uvulopalatopharyngoplasty (UPPP)
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Dr. David Fairbanks, author of Snoring and Obstructive Sleep Apnea, Third Edition (2003) states

“UPPP has been practiced and refined, praised and maligned, yet it remains the standard against which all other surgical procedures will be compared”.

UPPP stands for Uvulopaltopharyngoplasty.  It literally means to reshape the uvula, palate, and pharynx.  The internet is full of both horror stories and miraculous cures with this procedure.  The concept began over 50 years ago with palatal procedures being done and conceptualized by Ikematsu of Japan. In 1979, Fujita of the United States developed the more classic UPPP, similar to the one still practiced today. There have been several changes over the years to improve results, decrease the chance of complications, and reduce pain but the concepts have remained the same. The goals are:

1. To enlarge the airway
2. To stabilize the airway
3. To correct anatomical abnormalities

The main steps are to remove the tonsils and identify and remove redundant palate and uvula (that dangly thing at the back of your throat).

The procedure can be done with or without raising a mucosal flap, with electrocautery or with a ‘cold’ technique (using a scalpel), and there are variations in certain releasing incisions and stitching techniques. There is very little evidence in the literature to show one technique is better than another so most decisions are based on surgeon experience.

 

In my opinion, the key to success of the procedure are:

1. Leave a small part of the uvula (makes sure the palate can still reach the back wall of the throat to decrease the chance of liquid coming out your nose when you drink). Be conservative with midline resections.
2. Lift mucosal flaps first and conservatively trim mucosa. This makes sure the wound is closed without tension
3. Incise the posterior pillar at 45 degrees. The pillar is than advanced forward and up to stretch out the oropharyngeal tissue. This widens the throat and tightens it so there is less chance of collapse. The posterior pillar should never be stitched under tension as this would increase complications.
4. Goal is a boxy or rectangular look to the soft palate.
5. The ‘cold’ technique causes no burning of tissue therefore there is less ‘collateral damage’. In my patients this has resulted in significantly less pain and quicker return to work.

Again, I stress that these are my opinions and there is very little evidence to back them up however many other sleep surgeons share these opinions based on their own patient observations. The procedure is tailored to the individual so the procedure is not identical in everyone.


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