Uvulopalatopharyngoplasty (UPPP) Surgery
To resolve nighttime breathing disruptions and alleviate the symptoms of obstructive sleep apnea (OSA), non-surgical interventions like continuous positive airway pressure (CPAP) therapy may be used, as well as lifestyle modifications such as weight management or adjustment of sleep positions. When these treatments are not successful in reducing the symptoms of OSA, doctors may recommend alternative treatments including uvulopalatopharyngoplasty (UPPP), a surgery for sleep apnea.
We discuss this surgery, including its role in treating OSA, its potential benefits and risks, and what to expect before and after the procedure.
What Is UPPP Surgery?
Uvulopalatopharyngoplasty (UPPP) is a surgery that removes and repositions tissue within the airway to make it less likely to collapse and interfere with breathing during sleep. In people with obstructive sleep apnea, abnormal breathing occurs when tissue within the upper airway collapses in on itself, creating an obstruction Trusted Source National Center for Biotechnology Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . UPPP enlarges the airway by altering certain tissue in the throat such as the soft palate, uvula, and tonsils.
- Soft palate: The soft palate is located at the back of the roof of the mouth and is important for breathing, swallowing, and speaking Trusted Source National Center for Biotechnology Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . More than 90% of airway obstructions Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source during sleep may be related to blockages caused by the soft palate.
- Uvula: The soft palate ends at a piece of tissue hanging from the roof of the mouth called the uvula. Because a swollen or enlarged uvula is a frequent cause of airway obstruction, this tissue is often altered or removed during a UPPP.
- Tonsils: The tonsils are tissues found on both sides of the back of the throat that play a role in preventing infection. Larger than normal tonsils are another reason for reduced space in the airway and are a common target of surgery.
Variations of UPPP
A UPPP surgery is composed of several procedures, each targeting specific structures or abnormalities in the airway that contribute to obstructions during sleep. The choice of which procedures to include during a uvulopalatopharyngoplasty depends on the results of an examination of the mouth and airway as well as an individual’s unique anatomy.
- Tonsillectomy: A tonsillectomy is a procedure in which the tonsils are removed.
- Adenoidectomy: The adenoids are tissues that play a role in preventing infection and are located behind the nose at the top of the throat. When these tissues are removed during surgery, it is called an adenoidectomy.
- Uvulopalatal flap: A uvulopalatal flap procedure involves folding the uvula under the soft palate rather than removing it completely.
- Expansion sphincter pharyngoplasty: This procedure attempts to reinforce the side walls of the airway Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source by removing or repositioning tissues Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source within the throat.
- Palatal advancement pharyngoplasty: During a palatal advancement pharyngoplasty, a doctor removes a portion of the front two-thirds of the roof of the mouth known as the hard palate. This helps adjust the soft palate forward and reduce the risk of airway collapse.
- Relocation pharyngoplasty: Relocation pharyngoplasty repositions tissues in the throat to create tension on the sides of the airway Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source and decrease the likelihood of collapse.
In the past, UPPP focused primarily on removing tissue to expand the airway. Newer variations of UPPP have helped reduce the side effects of the surgery by attempting to reposition or rebuild tissues when possible.
UPPP Surgery for Obstructive Sleep Apnea
Doctors typically recommend uvulopalatopharyngoplasty surgery for the treatment of obstructive sleep apnea when less invasive treatments have been unsuccessful. When surgery is needed, UPPP is the most frequently performed procedure for adults with OSA.
The effectiveness of UPPP varies based on the part of the airway where obstructions occur and the specific surgical procedures performed. While this surgery can often reduce breathing disruptions and other symptoms of OSA, complete resolution of symptoms is uncommon.
UPPP is not commonly performed in children with OSA, as it is more common for children diagnosed with OSA to have the adenoids and tonsils removed to reduce sleep-related breathing problems. However, pediatricians may recommend UPPP in children with certain health conditions, such as Down syndrome.
Because of a lack of research about their effectiveness and the potential for side effects, UPPP and other surgeries for OSA are not recommended for pregnant people Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source .
UPPP Surgery for Snoring
Although not an initial treatment for snoring, uvulopalatopharyngoplasty may be recommended Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source if snoring has not gotten better after less invasive treatments and is caused by anatomic features that can be remedied through surgery.
UPPP surgery may be able to reduce snoring because the cause of snoring is often a mild version of the changes in the airway that occur in people with obstructive sleep apnea. People who snore have a partial narrowing of the airway. When air moves past tissues in the throat, those tissues vibrate and create the characteristic sounds of snoring.
While most people experience a reduction in snoring after a UPPP, only around half maintain this improvement long-term. UPPP is also an invasive procedure that involves receiving anesthesia and staying in a hospital overnight, so the drawbacks of the procedure often outweigh its benefits for people who snore but do not have sleep apnea.
Benefits and Drawbacks of UPPP Surgery for Obstructive Sleep Apnea
When deciding whether to pursue surgery for obstructive sleep apnea, it can be helpful to understand the benefits and drawbacks of UPPP.
Although past research can help people understand what to expect from surgery, it is important to remember that the specific procedures involved in a uvulopalatopharyngoplasty depend on an individual’s needs. Because variations of UPP can affect the surgery’s outcome, it is important to discuss questions about the benefits and drawbacks with a doctor.
Benefits of UPPP
The benefits of uvulopalatopharyngoplasty surgery depend on several factors, including the cause of airway obstructions and the procedures involved in the UPPP. In general, around half of people who undergo UPPP experience significantly fewer breathing disruptions during sleep after the operation. Other benefits of UPPP surgery can include:
- Reduced snoring
- Fewer nighttime awakenings
- Less daytime sleepiness
- Lower risk of accidents while driving
- Decreased risk of cardiovascular disease
- Improvements in overall quality of life
Drawbacks of UPPP
Potential side effects of uvulopalatopharyngoplasty include post-surgical pain, bleeding, and risk of infection. People who have UPPP surgery may also experience changes in their voice as well as temporary difficulty making certain sounds Trusted Source Merck Manual First published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers. View Source .
As many as one-third of people develop difficulties related to swallowing and eating after UPPP surgery. Serious side effects of UPPP are uncommon, and the majority of people see improvements in side effects during the first few months after the procedure.
While many people with obstructive sleep apnea experience improvements in symptoms after a UPPP surgery, some people find that their OSA comes back over time Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. View Source . Also, UPPP may not eliminate the need for other treatments such as continuous positive airway pressure (CPAP), and people often need to continue these treatments after the procedure.
Is UPPP Covered by Insurance?
Insurance may cover the cost of uvulopalatopharyngoplasty, but this depends on a person’s health insurance policy. For people with private medical insurance, contacting the insurance company directly is the best way to learn about what costs may be covered and what may need to be paid out of pocket.
For individuals with Medicare, uvulopalatopharyngoplasty is only covered under specific circumstances . Surgery must be needed for the treatment of moderate to severe obstructive sleep apnea that is caused by blockages in certain parts of the airway. For coverage to apply, less invasive treatments, such as CPAP therapy, must be attempted first, and a doctor must have a conversation with the patient about the risks and benefits of surgery.
Preparing for UPPP Surgery
Knowing what to expect before and after surgery may reduce anxiety about surgery and can help patients stay informed about their follow-up care plan.
Before UPPP Surgery
Prior to surgery, doctors evaluate a person’s health history and perform testing to determine whether they are a good candidate for uvulopalatopharyngoplasty. The primary care doctor may work directly with a surgeon to determine whether surgery is a safe and beneficial option. Doctors may also use this time to discuss other options for treating OSA and what to expect if a person goes forward with surgery.
An exam of the head and neck as well as imaging tests may be used to find the location of the obstruction and develop a plan for surgery. Because uvulopalatopharyngoplasty is performed under general anesthesia, additional tests may be performed to ensure that the surgery can be performed safely.
People scheduled for UPPP surgery should take standard precautions prior to surgery, including telling their doctor about any medications or supplements they take and informing the doctor if they could be pregnant. A doctor, nurse, or another medical professional will review any additional pre-operative instructions and what to expect prior to the day of surgery.
After UPPP Surgery
After waking up from uvulopalatopharyngoplasty, patients are monitored by a medical professional to ensure that the side effects of anesthesia diminish. An overnight hospital stay is often needed to make sure that a person can swallow before they are discharged.
Recovery from UPPP surgery can take two to three weeks, during which time people will be instructed to take any pain medication provided by the doctor, eat soft foods, rinse their mouth after meals, and avoid strenuous activity. During recovery, the symptoms of obstructive sleep apnea may temporarily become more severe Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source due to swelling and challenges in using positive airway pressure devices.
During the recovery period, it is important to contact a doctor if there are any unexpected side effects. While many people have a follow-up appointment with their doctor after two to three weeks, the timing of this appointment depends on the type of UPPP surgery that was performed.
Follow-up appointments may include an examination of the surgical site to check incisions and assess the structure of the airway. The doctor will also ask about any changes in symptoms or new side effects.
After the recovery period, patients typically meet with a sleep specialist for a follow-up sleep study to detect and measure any remaining symptoms of OSA and discuss any need for ongoing treatment, such as continued use of a CPAP device.
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