Uvulopalatopharyngoplasty

Admission of the throat eight years after UPPP

top left: preoperative; top right: standard UPPP; bottom left: modified UPPP; bottom right: minimal UPPP

Uvulopalatopharyngoplasty (UPPP) is an operation to reduce and tighten the soft palate . It is mainly used in the surgical therapy of obstructive sleep apnea . In 1964 uvulopalatopharyngoplasty was first described by T. Ikematsu. Since then, various modifications of the operation have been described and used with varying degrees of success.

Operational approach

The procedure is performed under general anesthesia with preferred nasal intubation . There is no sedating premedication to avoid persistent airway obstruction .

This operation removes fat and connective tissue in the throat area that could block the airways during sleep. This includes parts of the soft palate muscles , the uvula (suppository) and the base of the tongue . The uvula is folded towards the soft palate and sewn together.

A relaxometry is carried out to avoid a relaxan overhang . Follow-up care should be in the intensive care unit for 24 hours , with postoperative analgesia using only non-opioid analgesics .

Fujita uvulopalatopharyngoplasty

With uvulopalatopharyngoplasty as modified by Shiro Fujita , only the excess mucous membrane of the velum and uvula is resected without affecting the velum muscles . The uvulae muscle is also largely spared, so that no complications during the act of swallowing and phoning ( allowing the vocal sound to set in high pitch) were observed.

Laser-assisted uvulopalatoplasty

The laser-assisted uvulopalatoplasty (LAUP) was developed in the 1980s by Yves-Victor Kamami, a surgeon at the Marie-Louise Hospital in Paris, who in 1990 published his first article on the subject. Kamami claimed that this treatment was not only a successful treatment for snoring, but was also effective for obstructive sleep apnea. Subsequently, however, it was found in studies that the procedure led to a worsening of the existing apnea. These results are due to thermal damage to the laser beam. The laser can induce progressive palatal fibrosis and the resulting scar tissue can reduce the air space in the pharynx.

Stanford Protocol

An operation according to the Stanford protocol is much larger and consists of two separate operations. It is named after Nelson Powell and Robert Riley of Stanford University . The first surgery is soft tissue surgery that includes tonsillectomy and uvulopalatopharyngoplasty. If there is still residual sleep apnea, the second operation, which consists of a maxillomandibular dysgnathia operation, takes place . Here is the upper jaw and the lower jaw moved forward ( English Maxillomandibular Advancement ). The tongue muscle is anchored to the chin. The forward translation of the lower jaw also pulls the tongue forward, which means that the airways are no longer blocked. As the jaw moves forward, the shape of the face changes. The second operation is likely to be the cause of the greater success in the therapy of obstructive sleep apnea according to the Stanford protocol.

rating

UPPP with tonsillectomy is recommended for the treatment of obstructive sleep apnea syndrome (OSA) if the pathoanatomical findings are appropriate ( OCEBM recommendation grade B). The success rates after 6 months in most studies with patient selection are between 50% and 60%. Long-term success rates are lower and vary between 40% and 50%.

It could be shown that the success of UPPP in obstructive sleep apnea depends strongly on the volume of the removed tonsils. The larger the tonsils, the greater the reduction in pauses in breathing and thus the greater the success of the operation.

Modifications to the UPPP

Because of these rather low success rates, numerous modifications of the UPPP have been developed:

Extended uvulopalatal flap (EUPF)
Relocation pharyngoplasty
Expansion of the sphincter pharyngoplasty (ESP)
Z-palatoplasty (ZPP)
Lateral pharyngoplasty
Han-UPPP
Uvulopalatoplasty (UPP)
Radiofrequency Assisted Uvulopalatoplasty (RF-UPP)
Transpalatal advancement pharyngoplasty (TAP)

Further studies are pending in order to be able to make statements about a risk-benefit assessment.

Web links

Commons : Uvulopalatopharyngoplasty - Collection of Images, Videos and Audio Files

Wiktionary: uvulopalatopharyngoplasty - explanations of meanings, word origins , synonyms, translations

S2 guideline therapy of obstructive sleep apnea in adults of the German Society for Ear, Nose and Throat Medicine, Head and Neck Surgery (DGHNOKHC). In: AWMF online (as of 05.09.2015), 3.4.3.
K. Yaremchuk, L. Garcia-Rodriguez: The History of Sleep Surgery. In: Advances in oto-rhino-laryngology. Volume 80, 2017, pp. 17-21, doi : 10.1159 / 000470683 , PMID 28738337 .

literature

T. Verse, W. Pirsig: For the indication and implementation of uvulopalatopharyngoplasty and laser-assisted uvulopalatopharyngoplasty. In: ENT. 46, 1998, p. 553, doi : 10.1007 / s001060050269 .
Nelson B. Powell: Contemporary Surgery for Obstructive Sleep Apnea Syndrome. In: Clinical and Experimental Otorhinolaryngology. 2, 2009, p. 107, doi : 10.3342 / ceo.2009.2.3.107 .

Individual evidence

↑ ^a ^b T. Verse, BA Stuck: Modern modifications of uvulopalatopharyngoplasty . In: ENT . tape 65 , no. 2 , February 1, 2017, ISSN 1433-0458 , p. 90-98 , doi : 10.1007 / s00106-016-0300-1 .
^ Pinto Ja: Lessons from 50 Years of Uvulopalatopharyngoplasty . In: Journal of Sleep Disorders & Therapy . tape 5 , no. 3 , 2016, doi : 10.4172 / 2167-0277.1000246 ( omicsgroup.org [accessed April 17, 2019]).
↑ T. Ikematsu: Study of snoring, fourth report . In: Journal of Otolaryngology of Japan . tape 64 , 1964, pp. 434-435 .
↑ W. Pirsig, J. Schäfer u. a .: Uvulopalatopharyngoplasty without complications: a modification according to Fujita. In: Laryngo-Rhino-Otology. 68, 1989, p. 585, doi : 10.1055 / s-2007-998408 .
↑ F. Larrosa, L. Hernandez et al. a .: Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations? In: The European respiratory journal. Volume 24, Number 1, July 2004, pp. 66-70, PMID 15293606 .
↑ Kasey K. Li, Nelson B. Powell et al. a .: Long-Term Results of Maxillomandibular Advancement Surgery. In: Sleep and Breathing. 4, 2000, p. 137, doi : 10.1007 / s11325-000-0137-3 .
^ Samuel Tschopp, Kurt Tschopp: Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea . In: The Laryngoscope . tape 0 , no. 0 , ISSN 1531-4995 , doi : 10.1002 / lary.27899 ( wiley.com [accessed April 27, 2019]).

[:0-1] T. Verse, BA Stuck: Modern modifications of uvulopalatopharyngoplasty . In: ENT . tape 65 , no. 2 , February 1, 2017, ISSN 1433-0458 , p. 90-98 , doi : 10.1007 / s00106-016-0300-1 .

[2] Pinto Ja: Lessons from 50 Years of Uvulopalatopharyngoplasty . In: Journal of Sleep Disorders & Therapy . tape 5 , no. 3 , 2016, doi : 10.4172 / 2167-0277.1000246 ( omicsgroup.org [accessed April 17, 2019]).

[3] T. Ikematsu: Study of snoring, fourth report . In: Journal of Otolaryngology of Japan . tape 64 , 1964, pp. 434-435 .

[4] W. Pirsig, J. Schäfer u. a .: Uvulopalatopharyngoplasty without complications: a modification according to Fujita. In: Laryngo-Rhino-Otology. 68, 1989, p. 585, doi : 10.1055 / s-2007-998408 .

[5] F. Larrosa, L. Hernandez et al. a .: Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations? In: The European respiratory journal. Volume 24, Number 1, July 2004, pp. 66-70, PMID 15293606 .

[6] Kasey K. Li, Nelson B. Powell et al. a .: Long-Term Results of Maxillomandibular Advancement Surgery. In: Sleep and Breathing. 4, 2000, p. 137, doi : 10.1007 / s11325-000-0137-3 .

[7] Samuel Tschopp, Kurt Tschopp: Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea . In: The Laryngoscope . tape 0 , no. 0 , ISSN 1531-4995 , doi : 10.1002 / lary.27899 ( wiley.com [accessed April 27, 2019]).