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
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