Uvulopalatoplasty (UP2): a modified technique for selected patients.

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The goal of uvulopalatopharyngoplasty (UP3) in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) is to reduce obstruction by eliminating redundant tissue in three areas: the soft palate, tonsils, and pharynx. However, some OSAHS patients may present with tonsil hypertrophy and elongated soft palate without redundant pharyngeal folds. We treated this group of patients with tonsil reduction using radiofrequency coblation combined with uvulopalatoplasty (UP2) using a palatal flap technique without pharyngoplasty. Morbidity and outcome was then compared with a group of patients who underwent classic UP3. A retrospective, nonrandomized study comparing morbidity and outcomes of the modified technique (UP2) with patients who underwent standard UP3. Patients were all staged according to the previously described Friedman staging system. Those with redundant pharyngeal folds were treated with UP3 (n = 33), and those without redundant pharyngeal folds were treated with tonsil coblation and UP2 (n = 30). Charts of patients undergoing UP2 and UP3 between July 1, 2001 and July 1, 2002 were reviewed. Thirty-three consecutive patients who underwent UP3 were selected for study as well as 30 consecutive patients who underwent UP2. Pre- and postoperative quality of life questionnaires and patient questionnaires focusing on diet, pain, and return to activity were reviewed to assess subjective morbidity and elimination of symptoms. Objective measurements include preoperative and postoperative (6-18 months) polysomnography (PSG). Symptom elimination and objective PSG results were compared. There was no statistical difference in results between the UP3 group and the UP2 group. Morbidity, however, was significantly more prominent, and recovery was more prolonged, in the UP3 group. Patients undergoing UP2 had fewer pain days, less narcotic use, quicker return to solid diet, and less long-term complaints of globus sensation. UP2 with tonsil coblation offers some reduction in postoperative morbidity without affecting outcome for selected patients with OSAHS. Pain levels, however, are still very significant.