UUUP

UUUP which is known as Uvulopalatopharyngoplasty is a surgical method of treating patients who are suffering from severe OSA (Obstructive Sleep apnea). The presence of excessive tissue in the region of the upper soft palate usually tends to close the airway. UUUP is a surgery related to the uvula. In the UUUP surgery, the uvula is removed along with all or part of the upper soft palate.

Uvulopalatopharyngoplasty helps in treating sleep apnea and subsequently also helps in reducing snoring. This is only considered as an alternative treatment after the CPAP fails to show some improvement in a patient. This procedure increases the width of the airway at the throat opening. Consequently this improves the movement of the muscles in the region.

There are two different ways by which a patient goes through the UPPP surgery

1. Standalone procedure - Most patients undergo this procedure.
2. "The Stanford Protocol Operation" - In this case the patients undergo UPPP as the first procedure in a stepped plan. The way in which UPPP is administered greatly affects the overall prognosis of the intervention. The Stanford Protocol is essentially a "cocktail" of surgeries that aim to address the entire airway and thereby treat or cure sleep apnea. It is often found that Obstructive Sleep Apnea (OSA) usually involves multiple sites where the tissues obstruct the airway and the base of the tongue is often involved. The Protocol successively addresses these multiple sites of obstruction.

This protocol involves treatment in two phases.

a. The patient undergoes soft tissue surgery UPPP along with Genioglossus Advancement or Hyoid Suspension. After this phase, the patient is given a sleep study and reassessed.
b. Phase two involves the Maxillo-mandibular Advancement (MMA) surgery. This involves the movement of the jaws forward to facilitate breathing. Approximately 90-percent of patients get better in this phase of treatment.

The Effectiveness of UUUP

1. As a standalone procedure the results has been disappointing in most cases. Since apnea is caused by multiple coexisting obstructions at various parts of the airway like the nasal cavity and the base of the tongue, it is noticed in many patients that the breathing tends to improve immediately but the improvements tends to deteriorate after a period of two years. Research shows that UPPP as a standalone procedure is less than 40-percent effective.
2. As the "Stanford protocol" operation, which involves regular follow up PSG testing, it is noticed that approximately 60 - 70 percent have been cured and around 90-percent of patients have shown improvement.

The Risks

Sometimes, since the tissues are cut, excess cutting can lead to tightening of the airway thereby making it smaller. This can later cause some breathing difficulty. Some patients have complained to have severe acid reflux after the operation.

Post Surgery Complications

1. Sleepiness due to post surgery medications
2. Sore throat or swelling at the operated area.
3. Narrowing of airway between nose and throat, which can lead to apnea conditions again.
4. Difficulty in swallowing
5. Infection or bleeding
6. Drainage into nose affecting the speech