Uvulopalatopharyngoplasty also known as UPPP is a surgical procedure used to remove or modify tissue in the throat. This is done mostly due to sleep issues. The tissues which may be removed during the procedure include:
- The adenoids
- The tonsils
Tissues which may be remodelled include:
- The soft palate
- The uvula
- The pharynx
What is involved in UPPP Surgery?
UPPP usually involves the removal of the tonsils, the posterior surface of the soft palate and the uvula. The uvula is then folded toward the soft palate and stitched together. UPPP is the most commonly performed procedure for obstructive sleep apnoea in the US. The procedure is mostly successful in individuals who are not obese.
UPPP Surgery – The Procedure
Standard UPPP procedure
The standard UPPP procedure is usually administered to patients with obstructive sleep apnoea in isolation. The procedure is done as a stand-alone with the likelihood that the tissue which obstructs the airway is localized in the back of the patient’s throat. The patient’s airway will be wider, and breathing will become easier by removing the tissue.
The Stanford Protocol Operation
The Stanford protocol is a combination of procedures that involves UPPP which are undertaken to treat obstructive sleep apnoea. It consists of two phases:
- Phase 1 which involves surgery of the soft tissue (tonsillectomy, UPPP)
- Phase 2 involves skeletal procedures (maxillomandibular advancement)
First, phase 1 or tissue surgery is done and after re-testing with a new sleep study, if there is still residual sleep apnoea, the phase 2 which consists of jaw surgery is performed. The goal is to improve the airway by treating or possibly curing sleep apnoea. Obstructive sleep apnoea usually involves multiple sites where tissue is obstructing the airway – the base of the tongue is usually involved. The Stanford protocol addresses these multiple sites of obstruction.
Phase 2 involves maxillomandibular advancement procedure which moves the jaw top (maxilla) and bottom (mandible) forward. The tongue muscle is anchored to the chin, and by moving the mandible forward, pulls the tongue forward as well. If the procedure achieves the desired results, the tongue relaxes when the patient sleeps and it will no longer be able to block the airway.
Results of UPPP in Isolation
When UPPP is done in isolation, the results vary. As explained, sleep apnoea is often caused by multiple co-existing obstructions at various locations of the airway such as the base of the tongue and the nasal cavity. The contributing factors in the success of the procedure include the size of the palate, uvula, tonsils, and the tongue base. Also, morbidly obese individuals are less likely to have success from this surgery.
Results of the Stanford Protocol Procedure
Of the people who have undergone the Stanford Protocol operation, 60-70 percent of them have been entirely cured. About 90% of the patients, have seen a significant improvement.
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