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Modified Uvulopalatopharyngoplasty With Uvula Preservation

1 Introduction A narrow upper airway is one of the main causes of obstructive sleep apnea (OSA). Uvulopalatopharyngoplasty (UPPP), which ablates both the two tonsils and part of the redundant soft palate to decrease the oropharyngeal obstruction, is used as an alternative treatment for OSA. Application of the classic UPPP is limited by variable effectiveness in unselected patients and a relative high rate of complications, such…

The Uvulopalatal Flap

1 Introduction It is obvious to the reader of this textbook that there is a plethora of obstructive sleep apnea (OSA) palatal surgeries. Because palatal anatomy varies between individuals, different palatal techniques have been devised to treat the pharyngeal “sphincter” by addressing the lateral pharyngeal muscles or advancing the palate anteriorly while sparing the uvula. The uvulopalatal flap (UPF) procedure is a variation of uvulopalatopharyngoplasty (UPPP).…

Zetapalatopharyn­goplasty (ZPP)

1 Introduction The uvulopalatopharyngoplasty (UPPP), as described by Fujita in 1981, marked a breakthrough for the evolving field of sleep surgery. However, the procedure's limited success and cure of obstructive sleep apnea/hypopnea syndrome (OSAHS) resulted in the need to develop modifications of UPPP. Nevertheless, its role as part of a comprehensive treatment plan remains solidly accepted in most situations in which the palate, with or without…

Uvulopalatopharyn­goplasty: The Fairbanks Technique

1 Introduction Uvulopalatopharyngoplasty (UPPP) is generally both safe and effective as a surgical treatment for nonobese patients who suffer with mild to moderate sleep apnea. This refinement in surgical technique employs strategies to avoid complications and improve efficacy. Palatal dysfunction is avoided by minimizing soft palate shortening in the midline (uvula) area. Nasopharyngeal stenosis is avoided by minimizing posterior pillar resection and avoiding pharyngeal undermining. Effectiveness…

Uvulopalatopharyn­goplasty: Patient Selection and Effects on the Airway

1 Introduction Uvulopalatopharyngoplasty (UPPP), first described by Fujita in 1981, was the first surgical procedure specifically designed to treat snoring and obstructive sleep apnea (OSA), and it is still the most commonly used surgical procedure for these conditions. The original procedures of UPPP include excision of the tonsils, trimming and relocating the tonsillar pillars, uvulectomy, and mucosal closure of the soft palate. Although UPPP can successfully…

Classic Uvulopalatopharyngoplasty

1 Introduction In the last 20 years the surgical management of obstructive sleep apnea (OSA) and snoring has seen a continuous expansion and refinement. As surgeons gained more information about airway mechanics and physiology, many new procedures have been developed that are tailored for reconstruction and stabilization of not only specific levels of the airway but also particular mechanisms of collapse within each level. Newer procedures…

Palatal Implants for Primary Snoring: Short- and Long-Term Results of a New, Minimally Invasive Surgical Technique

1 Introduction Snoring is a widespread symptom affecting about 50% of the adult population. Primary snoring without sleep-disordered breathing is not harmful in itself. However, because snoring often causes social embarrassment and marital disharmony, affected patients apply to their physicians for treatment. The primary therapeutic aim of all available therapies is a reduction in the duration and intensity of snoring to a tolerable degree without harming…

Elevoplasty

Elevoplasty is a minimally invasive physician's office intervention to treat patients who present with mild to moderate snoring who choose not to wear an appliance to assist with sleep and are unwilling to undergo uvulopalatopharyngoplasty (UPPP) surgery. It works by stiffening the soft palate by shortening it. Unlike other minimally invasive palate systems that only stiffen, Elevoplasty also lifts the palate using a custom-designed resorbable suture…

Sling Snoreplasty

1 Introduction Snoring is a highly prevalent condition consisting of irregular respiratory sounds during sleep that are sufficiently loud enough to disturb a bed partner. A recent large health survey found that 53% of adult Americans were regular snorers, including 59% of adult men and 46% of adult women. The high prevalence among adults is due in part to the rising incidence of obesity, with 71%…

Injection Snoreplasty

1 Introduction A vast array of choices is available to the otolaryngologist to treat simple snoring. The majority of these procedures function via the principle of palatal stiffening in which the vibrating floppy soft palate of the snoring patient is stiffened by creating scar tissue in or on the palate. Injection snoreplasty (IS) was originally developed as a modification of a solitary, indistinct case series published…

Cautery-Assisted Palatal Stiffening Operation and Anterior Palatoplasty

1 Introduction Snoring is caused by the vibration of the structures in the oral cavity and oropharynx—namely the soft palate, uvula, tonsils, base of tongue, epiglottis, and pharyngeal walls. Most authorities would concur that over 80% of snoring is due to palatal flutter, caused by vibration of the uvula and the soft palate. Hence, it would be conceivable that techniques to stiffen the palate would be…

Role of Laser Surgery in Treatment of OSA

1 Introduction Laser-assisted uvulopalatoplasty (LAUP) is a surgical procedure for the treatment of snoring and mild obstructive sleep apnea/hypopnea syndrome. LAUP involves the use of a surgical laser to sequentially reduce and reshape the tissues of the uvula and soft palate. Initially described by Dr. Yves-Victor Kamami in 1986, LAUP has been widely performed in the United States since 1993 to remove excessive vibratory tissue of…

Inferior Turbinate Reduction

1 Introduction The inferior turbinate is the largest of the three paired turbinates and plays a large role in humidifying and filtering air, as well as directing airflow through the nose. The inferior turbinate consists of the turbinate bone covered with erectile soft tissue and nasal respiratory epithelium. Inferior turbinate hypertrophy can be caused by generalized nasal mucosal disease in allergic and nonallergic rhinitis, as well…

New Techniques in Nasal Valve Repair

1 Introduction Sleep-disordered breathing and snoring are exceedingly common presentations to physicians. In general, the etiology is highly variable from base of tongue obstruction, laryngomalacia, retrognathia, or weak pharyngeal muscle tone, among others. These etiologies can all be exacerbated by coexistent nasal valve obstruction as it directly relates to airflow. Common etiologies of nasal valve collapse include aging, trauma, congenital, septal deviation, and, most frequently, iatrogenic…

Plastic Surgery Techniques for Correction of Nasal Obstruction

1 Introduction Difficulty breathing through the nose is one of the most frequent complaints presented to an otolaryngologist. Nasal septal deviation and turbinate hypertrophy are easily identified as areas of anatomic obstruction. One area that can be overlooked as an etiology for obstruction is an incompetent nasal valve. Nasal valve obstruction can markedly reduce airflow through the anterior nostril. This reduction in flow can contribute to…

Minimally Invasive Nasal Valve Repair

1 Introduction The nasal valve is defined as the flow-limiting segment of the nasal airway, located at the triangular aperture between the upper lateral cartilage and the septum. The angle formed by these two structures ranges from 10 to 15 degrees and is maintained by the relationships between the nasal septum, the lower lateral cartilage, and the attachments of the facial muscles. The valves constitute the…

Nasal Obstruction and Sleep-Disordered Breathing

1 Nasal Obstruction and Sleep-Disordered Breathing The link between nasal airway obstruction (NAO) and restless sleep has been known since antiquity: Hippocrates reported an association between poor sleep and nasal polyposis. Case reports and series as early as the 1890s showed an association between the nasal valve and sleep-disordered breathing (SDB). Modern studies report that subjective or objective NAO is a risk factor for SDB. Approximately…

Algorithm for Multilevel Treatment: Friedman Experience

Effective surgical treatment for obstructive sleep apnea/hypopnea syndrome (OSAHS) must be designed to eliminate collapsible soft tissue in the upper airway without interfering with normal function. Creation of a noncollapsible airspace and reduction of airway resistance enable maintenance of adequate airflow with normal inspiratory effort. This translates into elimination or reduction of apneic/hypopneic episodes during sleep and control of symptoms and further minimizes ongoing multisystem damage…

The Effect of Oral Positioning on Hypopharyngeal Airway Dimensions

1 Introduction It is widely accepted that particular mouth and tongue positions affect patency of the upper airway. Specifically, mouth opening is believed to decrease the cross-sectional area, whereas tongue protrusion is believed to increase the dimensions of the upper airway. Variable response to mouth opening and tongue protrusion may be responsible for inconsistent response to targeted treatment options for obstructive sleep apnea/hypopnea syndrome (OSAHS). Nasal…

Lingual Tonsil HypertrophyGrading System

Consideration of the complex relationship between sites of airway obstruction is paramount to choosing the correct surgical approach to treatment. Selecting patients who are likely to respond to surgery necessitates preoperative evaluation of individual patient anatomy. Lingual tonsil hypertrophy (LTH) is a common cause of hypopharyngeal obstruction. The degree of hypertrophy should be assessed, as it reflects the degree of morbidity. Therefore a universal language is…