Uvulopalatopharyngoplasty (UPPP) Surgery

Overview  

Uvulopalatopharyngoplasty (UPPP) is a surgical procedure designed to improve airflow by removing or reshaping tissues in the throat. It is commonly used to treat obstructive sleep apnea (OSA), a condition where the airway becomes blocked during sleep. By addressing the tissue obstructions, UPPP helps individuals breathe more easily, reducing interruptions during sleep. 

During UPPP, a surgeon may remove or reshape parts of the soft palate, uvula, and tonsils. The soft palate, located at the back of the mouth, may be shortened or altered. The uvula, the small, teardrop-shaped tissue hanging in the throat, may be partially or entirely removed. The tonsils, fleshy mounds at the back of the throat, may also be removed if they contribute to the airway obstruction. 

UPPP can be performed as a standalone procedure, but it is often combined with other surgeries to address structural issues in other parts of the airway. While UPPP focuses on removing tissue from the back of the throat, additional surgeries may be required to correct problems in the nasal cavity or deeper in the airway to ensure optimal results for sleep apnea treatment.

Reasons for undergoing the procedure  

UPPP (Uvulopalatopharyngoplasty) may be an option for treating obstructive sleep apnea (OSA) when conservative therapies haven’t been effective. First-line treatments typically include: 

• Devices that help open your airways, such as CPAP machines 
• Weight loss (since obesity and being overweight are significant risk factors for OSA) 

Determining eligibility for UPPP 

Research indicates that UPPP is most effective depending on the individual’s anatomy and weight. Healthcare providers use a staging system based on these factors to assess whether someone is a good candidate for the procedure. 

Key factors providers consider: 

• Tonsil size 
• Positioning of the soft palate in relation to the tongue 
• Body mass index (BMI) 

Staging system: 

Providers classify candidates into Stages 1, 2, or 3 based on these characteristics: 

• Stage 1: Likely to experience improvement in OSA symptoms after UPPP 
• Stage 2 & 3: Less likely to benefit significantly from the surgery 

If you’re considering UPPP, talk to your healthcare provider about the factors that will determine if you’re a good candidate for this surgery. 

Risks

Surgery carries inherent risks, including bleeding and infection, as well as the possibility of anesthesia-related allergies. Specific complications associated with Uvulopalatopharyngoplasty (UPPP) include:  

• Nasopharyngeal Stenosis: Scar tissue may form, narrowing the airway and causing sensations of tightness, dryness, or a feeling of something being lodged in your throat. While this is a rare complication, it may necessitate further surgery to correct.  
• Velopharyngeal Insufficiency: This condition occurs when the soft palate and throat fail to work together effectively to close off the nasal passages. As a result, liquids may inadvertently enter the nose while drinking. If this happens post-surgery, it is typically a temporary issue.  
• Voice Changes: After the procedure, your voice may sound higher or more nasal for a short period. If the entire uvula is removed, you will lose the ability to produce uvular consonants—sounds made with the back of the tongue and the uvula. This type of consonant is present in languages such as Danish, French, German, Hebrew, and Swedish.

Before undergoing surgery, it’s important to discuss potential risks and complications with your doctor to ensure you are well-informed about what to expect.  

Before the procedure  

You will go over the preparation processes for UPPP with your healthcare professional. Prior to surgery:  

• Discuss your medical history with your doctor. Share any medical conditions, past surgeries, and any reactions to anesthesia. Inform them if you are pregnant or planning to become pregnant, and disclose any medications or supplements you are currently taking.  
• Stop using tobacco products. Smoking, using e-cigarettes, or chewing tobacco can slow down your recovery. If you use tobacco, ask your doctor for help creating a plan to quit.  
• Follow your doctor’s instructions regarding fasting and medications. Your doctor will advise you on when to stop eating or drinking and what medications to take or avoid before surgery.  
• Arrange for transportation and care after the procedure. Ensure someone is available to drive you home from the hospital and, if possible, have a loved one stay with you for at least 24 hours after discharge.  
• Prepare to bring your CPAP machine to the procedure. If you use a CPAP machine, follow your doctor’s instructions for its use in the days leading up to your surgery and bring it with you to the hospital.  
• Notify your doctor if you become ill. If you feel unwell, contact your healthcare provider, as you may need to reschedule your surgery.  

During the procedure  

• You’ll be given anesthesia to put you to sleep and a sedative to help you relax. During the whole procedure, you will be unconscious.  
• To facilitate easy access to the tissue in the back of your throat, your surgeon will stabilize your tongue and prop your mouth open. Your head and neck will be positioned so that your airway is unobstructed.  
• It will be marked by your surgeon as necessary tissue to be removed.  
• Your tonsils, uvula, and maybe some of your soft palate will be removed whole or in part by your surgeon. They might employ electrocautery or a sharp object. Heat is used in electrocautery to create tissue incisions.  
• Sutures will be used to seal the wounds. Perhaps the sutures can dissolve.

Depending on which structures your doctor eliminates or restructures, surgery could take up to two hours. The timing also relies on whether you’ll require further treatments to deal with structural problems that are causing your sleep apnea.  

After the procedure  

You may either spend one night in the hospital or be discharged on the same day of your surgery. Your doctor will closely monitor your vital signs during this time. Once your breathing is stable and you are able to swallow safely, you will be cleared to go home.  

Your doctor will work with you to manage any pain as you recover. Before leaving the hospital, they will prescribe painkillers for you to take at home.  

Outcome 

Recovery after surgery typically takes up to four weeks, depending on the procedure’s complexity. During this time, it’s essential to take a break from work or school to allow your body to heal. Be sure to follow your doctor’s post-operative instructions carefully, as they will inform you about normal healing symptoms and those that may indicate complications. If you plan to continue using CPAP, consult your doctor about when it’s safe to resume. 

Weeks 1 & 2:  

• Activity: Avoid strenuous activities but stay moderately active to reduce the risk of blood clots. Consult your doctor to understand which activities to avoid and which can help with recovery. 
• Diet: Start with clear liquids immediately after surgery, and gradually introduce soft foods as you feel comfortable. Avoid spicy, acidic, hard, or crunchy foods that may irritate your mouth. Stick to cold or room-temperature foods and beverages to reduce discomfort. 

Weeks 1, 2, & 3:  

• Diet: Continue with soft, gentle foods as your healing progresses. Pay attention to how your body responds, and avoid any foods that might cause irritation. 

Up to 1 month:  

• Throat soreness: It’s normal to experience throat soreness, especially when speaking or swallowing. Your doctor will prescribe pain medication to help manage this discomfort. Follow your prescribed medication routine to stay comfortable throughout your recovery. 

By following these guidelines, you can support a smoother recovery process and reduce the risk of complications.