Uvulopalatopharyngoplasty (UPPP)

  • Definition
    • Uvulopalatopharyngoplasty (UPPP) is surgery to open the upper airways by taking out extra tissue in the throat. It may be done to treat mild obstructive sleep apnea (OSA) or severe snoring.

  • Alternative Names
    • Palate surgery; Uvulopalatal flap procedure; UPPP; Laser-assisted uvulopalaplasty; Radiofrequency palatoplasty; Velopharyngeal insufficiency - UPPP; Obstructive sleep apnea - uvulopalaplasty; OSA - uvulopalaplasty

  • Description
    • Surgery known as uvulopalatopharyngoplasty (UPPP) removes soft tissue at the back of the throat. This includes:

      • All or part of the uvula (the soft flap of tissue that hangs down at the back of the mouth).
      • Parts of the soft palate and tissue at the sides of the throat.
      • Tonsils and adenoids, if they are still there.
  • Why the Procedure is Performed
    • Your doctor may recommend this surgery if you have mild obstructive sleep apnea (OSA).

      • Try lifestyle changes, such as weight loss or changing your sleep position.
      • Most experts recommend trying to use CPAP or an oral device to treat OSA first.

      Your doctor may recommend this surgery to treat severe snoring, even if you do not have OSA. Before you decide about this surgery:

      • See if weight loss helps your snoring.
      • Consider how important it is to you to treat snoring. The surgery does not work for everyone.
      • Make sure your insurance will pay for this surgery. If you do not also have OSA, your insurance may not cover the surgery.

      Sometimes, UPPP is done along with other more invasive surgeries to treat more severe OSA.

  • Risks
    • Risks for any surgery are:

      • Allergic reactions to medicines
      • Breathing problems
      • Heart problems
      • Bleeding
      • Infection

      Risks for this surgery are:

      • Damage to the muscles in the throat and soft palate. You may have some problems keeping liquids from coming up through your nose when drinking (called velopharyngeal insufficiency). Most often, this is only a temporary side effect.
      • Mucus in the throat
      • Speech changes
  • Before the Procedure
    • Be sure to tell your doctor or nurse:

      • If you are or could be pregnant
      • What drugs you are taking, including drugs, supplements, or herbs you bought without a prescription
      • If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day

      During the days before the surgery:

      • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
      • Ask your doctor which drugs you should still take on the day of your surgery.

      On the day of the surgery:

      • You will usually be asked not to drink or eat anything for several hours before the surgery.
      • Take any drugs your doctor told you to take with a small sip of water.
      • Your doctor or nurse will tell you when to arrive at the hospital.
  • After the Procedure
    • This surgery most often requires an overnight stay in the hospital to make sure you can swallow. UPPP surgery can be painful and full recovery takes 2 or 3 weeks.

      • Your throat will be very sore for up to several weeks. You will get liquid pain medicines to ease the soreness.
      • You may have stitches in the back of your throat. These will dissolve or your doctor will remove them at the first follow-up visit.
      • Eat only soft foods and liquids for the first 2 weeks after surgery. Avoid crunchy foods or foods that are hard to chew.
      • You will need to rinse your mouth after meals with a salt-water solution for the first 7 to 10 days.
      • Avoid heavy lifting or straining for the first 2 weeks. You may walk and do light activity after 24 hours.
      • You will have a follow-up visit with your doctor 2 or 3 weeks after the surgery.
  • Outlook (Prognosis)
    • Sleep apnea improves at first for about half of the people who have this surgery. Over time, the benefit wears off for many people.

      Some studies suggest that surgery is best suited only for people with abnormalities in the soft palate.

  • References
    • Aurora RN, Casey KR, Kristo D, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010;33(10):1408-13. PMID: 21061864

      Braga A, Grechi TH, Eckeli A, et al. Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome. Sleep Medicine. 2013 Dec;14(12):1266-71. PMID: 24152797

      Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, et al. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep. 2010 Oct;33(10):1396-407. PMID: 21061863

      Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P. Management of Obstructive Aleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2013;159(7):471-83. PMID: 24061345

      Wakefield T, Lam DJ, Ishman SL. Sleep apnea and sleep disorders. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 18.