Uvulopalatal Flap Research Articles

Concurrent palatal implants and uvulopalatal flap: Safe and effective office-based procedure for selected patients with snoring and obstructive sleep apnea syndrome

An outpatient surgical procedure for snoring and obstructive sleep apnea syndrome (OSAS) should not only stiffen the soft palate, but also widen the opening of retropalatal space. This study presents a concurrent palatal implants (PI) and uvulopalatal flap (UPF) in the outpatient setting under local anesthesia for OSAS patients. Prospective study. Patients with snoring and more than or an equivalent of 5 events hourly but less than 20 hourly on the apnea-hypopnea index (AHI) were enrolled. Three office-based procedures were performed, that is, PI, UPF, and PI concurrent with UPF (PI-UPF). Postoperative pain was evaluated using a visual analog scale. Before surgery and after surgery, subjective outcomes were assessed using the snoring scale, and objective outcomes were assessed using overnight polysomnography. Sixty-three patients underwent office-based procedures for OSAS. Among them, 21 underwent PI, 20 underwent UPF, and 22 underwent PI-UPF. PI attained the lowest postoperative pain scores. At 6 months after surgery, the mean snoring scale in PI, UPF, and PI-UPF group were 3.7 ± 0.7, 3.2 ± 0.8, and 1.8 ± 0.6, respectively (P < .05). The mean AHI scores in group PI, UPF, and PI-UPF were 9.0 ± 4.6, 8.8 ± 4.0, and 6.1 ± 2.5 events per hour, respectively (P < .05). The mean snoring index in group PI, UPF, and PI-UPF were 120.6 ± 79.5, 115.7 ± 86.3, and 71.8 ± 41.7 events per hour, respectively (P < .05). Concurrent PI and UPF is a safe and effective office-based procedure for selected patients with OSAS and snoring.

Non-CPAP therapies in obstructive sleep apnoea

In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

Vessel sealing system uvulopalatoplasty versus uvulopalatal flap: a randomized, controlled study of efficacy and adverse effects

The objective of this randomized, controlled study is to compare intraoperative blood loss, operative time, postoperative pain and postoperative adverse effects (bleeding, velopharyngeal insufficiency and others) between vessel sealing system uvulopalatoplasty (VSSU) and uvulopalatal flap (UPF). The study was conducted at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 31 subjects with sleep-disordered breathing and obstruction at the retropalatal level were enrolled consecutively. Intervention was randomized by mixed block randomization into 2 groups (UPF, VSSU). Stratification was also done by the presence or absence of concomitant tonsillectomy. Measured outcomes, which were blinded to patients and outcome assessor, were intraoperative blood loss, operative time, postoperative pain, postoperative bleeding, postoperative velopharyngeal insufficiency and other adverse effects. Median (IQR) of intraoperative blood loss from VSSU and UPF was 0.00 (0.00-1.00) and 6.00 (1.25-12.75) ml (p < 0.001). Median (IQR) of operative time from VSSU and UPF was 3.50 (3.00-5.00) and 15.00 (12.25-18.00) min (p < 0.001). There was significantly less pain in VSSU group on operative day (p = 0.001) and postoperative day 1 (p = 0.009). However, no significant difference of pain on postoperative day 2 to day 14 (p = 0.055-0.983) between both groups. Regarding postoperative bleeding, 1 case of immediate bleeding in UPF group and 1 case of delayed bleeding in VSSU group were found in this study. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups. In conclusion, VSSU was better than UPF in terms of less intraoperative blood loss, less operative time and less pain in early postoperative period. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups.

Modified tongue base suspension for multilevel or single level obstructions in sleep apnea: Clinical and radiologic results

To investigate the radiologic and polysomnographic success in opening the airway using a tongue base suspension procedure alone or in combination with uvulopalatal flap in obstructive sleep apnea syndrome (OSAS) patients. This study was conducted in 20 patients with moderate or severe OSAS in a prospective manner. The tongue base suspension technique alone or with a uvulopalatal flap (UPF) technique was applied. Magnetic resonance imaging (MRI) scans of patients obtained during the preoperative period and at the 5th week of the postoperative period were compared. Changes in pain and swallowing difficulties were assessed. Polysomnography (PSG) was applied at the 12th postoperative month, and body mass index (BMI) and Epworth sleepiness scale (ESS) values were determined. The degree of satisfaction relative to the surgery was assessed with 4 questions. Preoperative apnea-hypopnea index (AHI) level was found to be 24.55±9.87, whereas postoperative AHI level was 12.40±9.87 (P<0.01). The success rate was determined to be 60%. Preoperative ESS values were 13.90±2.67 and were reduced to 6.55±3.13 postoperatively (P<0.01), and the preoperative posterior airway space (PAS) level was 10.08±1.23, which was increased to 11.64±1.46 postoperatively (P<0.01). Visual analog scale (VAS) values for swallowing difficulty were 8.62 at day 1 and decreased to 3.98 at day 7. The VAS values for pain were 9.14 at day 1, but were reduced to 4.18 at day 7. Patients with OSAS who have hypertrophy of the tongue base may safely receive a tongue base suspension procedure, which is a minimally invasive method. The postoperative hospital stay is short and the success rate is high, as shown with both PSG and MRI.

Uvulopalatal flap for obstructive sleep apnea: Short‐term and long‐term results

To study long-term results in patients undergoing uvulopalatal flap (UPF) for obstructive sleep apnea (OSA). Prospective, clinical trial at tertiary referral center. A study was undertaken on 83 OSA patients with palatal obstruction based on radiography and physical findings. UPF was conducted to increase the airway space and data were analyzed. Patients had a mean age of 36.5 ± 12.3 years and a mean body mass index (BMI) of 29.4 ± 4.3 kg/m(2) . The mean follow-up was 54.2 ± 8.9 months, with a range of 48 to 62 months. The mean baseline apnea-hypopnea index (AHI), short-term AHI, and long-term AHI were 45.6 ± 10.3, 13.4 ± 5.2, and 19.4 ± 5.1, respectively. The mean baseline lowest oxygen saturation (LSAT), short-term LSAT, and long-term LSAT were 82.6 ± 5.4%, 89.2 ± 4.8%, and 88.1 ± 3.2%, respectively. Forty-three patients (51.8%) had long-term success, and 15 patients(25.8%) had an increase in the AHI over the follow-up period such that they were no longer considered success by traditional AHI criteria. Serious complications were not encountered. UPF is a safe and effective procedure that results in long-term success for OSA. However, a regular follow-up is important because some patients will relapse in the long term.

Comparative Analysis for the Surgical Outcomes of Uvulopalatal Flap and Palatal Muscle Resection in Patients with Obstructive Sleep Apnea

Received March 24, 2011 Revised June 2, 2011 Accepted June 14, 2011 Address for correspondence Kyu-Sup Cho, MD Department of OtorhinolaryngologyHead and Neck Surgery, Pusan National University School of Medicine, 305 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel +82-51-240-7824 Fax +82-51-246-8668 E-mail choks@pusan.ac.kr Background and ObjectivesZZThe purpose of this study was to compare the surgical outcomes of uvulopalatal flap (UPF) and palatal muscle resection (PMR) techniques in the treatment of obstructive sleep apnea (OSA). Subjects and MethodZZForty-three consecutive patients (40 men and 3 women) with OSA were included. Only patients with Fujita type I obstruction were enrolled in this study. Patients with macroglossia or retrognathia were excluded from the study. Twenty patients underwent a UPF and twenty-three patients underwent a PMR. In both groups, nasal surgery was performed if necessary. Questionnaires based on Visual Analogue Scale (VAS) about snoring, apnea, morning headache, tiredness, daytime sleepiness and Epworth Sleepiness Scale (ESS) were analyzed before and after each surgical treatment. Preoperative and postoperative polysomnography (PSG) were completed by every patient. ResultsZZIn UPF group, every aspect of VAS except morning headache was significantly improved after surgery. In PMR group, every aspect of VAS and ESS were significantly improved after surgery. Comparing the surgical outcomes between two groups, every VAS and ESS showed much better result in PMR than UPF group. In both UPF and PMR group, the mean apnea-hypopnea index decreased significantly after surgery. However, there’s no significant difference between two groups in the PSG findings. ConclusionZZPMR could be a better surgical technique than UPF with respect to subjective outcome although both UPF and PMR are effective surgical techniques for the treatment of OSA with Fujita type I obstruction. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:467-72

The treatment of obstructive sleep apnea patient using extended uvulopalatal flap: a case report

The uvulopalatal flap (UPF) technique is a modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of obstr uctive sleep apnea. In the UPF technique, an uvulopalatal flap is fabricated and sutured to the residual mucosa of the soft palate to expand the anter o-posterior dimensions of the oropharyngeal inlet. In the extended uvulopalatal flap (EUPF) technique, an incision at the tonsillar fossa is added to the classical UPF technique followed by the removal of mucosa and submucosal adipose tissue for additional expansion of the lateral dimension. The EUPF tec hnique is more conservative and reversible than UPPP. Therefore, complications, such as velopharyngeal insufficiency, dysphagia, dryness, naso pharyngeal stenosis and postoperative pain, are reduced. In the following case report, the patient was diagnosed with obstructive sleep apnea and t reated with the EUPF technique. The patient’ s total respiratory disturbance events per hour (RDI) was decreased to 15.4, the O 2 saturation during the sleep was increased, and the excessive daytime sleepiness had disappeared after the surgery without complications. The authors report this case with a review of the relevant literature.

Does the dimple point represent the margin of soft palate musculature

Objective: To evaluate and compare the length of the soft palate from the posterior nasal spine (PNS) to the dimple point and, to the posterior margin of soft palate musculature. Material and methods: A prospective descriptive study was made. Two hundred-seven patients, who underwent uvulopalatal flap for sleep-disordered breathing between Jan 2003 and Dec 2006, were recruited for the study. The length from PNS to the dimple point of the soft palate (PNS-Dimple) was measured. After the mucosa on the outlined soft palate were removed, measurement of the length from PSN to the posterior border of the soft palate musculature (PNS-Muscle) was recorded. Results: Lengths of PNS-Dimple and PNS-Muscle were 24.3±3.2 and 24.5±3.5 mm (mean±SD), respectively. There were no statistically significant differences between the lengths (p=0.40; r=0.7). Mean lengths of PNS-Dimple and PNS-Muscle in OSA patients were significantly longer than those in primary snoring patients. Conclusion: When undertaking soft palate surgery for sleep-disordered breathing, removal of the soft palate should not exceed the dimple point which represents the posterior border of the soft palate musculature in order to prevent postoperative velopharyngeal insufficiency.

Comparison of Uvulopalatopharyngoplasty and Uvulopalatal Flap in Turkish Military Personnel With Primary Snoring

To compare the surgical results of uvulopalatopharyngoplasty (UPPP) and uvulopalatal flap (UPF) procedures in the treatment of primary snoring. Two study groups were formed and UPPP and UPF procedures were performed. All patients were stratified according to the modified Friedman staging system. Patients with tonsil size 2-4, palatal position scale grade 2, and body mass index lower than 30 were enrolled in the study. The success of surgical procedures was evaluated by applying a snoring questionnaire and Epworth sleepiness scale preoperatively and 90 days after the operation. Patients were followed for postoperative pain and other complications. Snoring was relieved in 85% of UPPP and in 83.3% of UPF patients 90 days after the operation. Postoperative pain complaint was more prominent in the UPPP group and mean duration of pain was significantly longer compared with the UPF group. Despite similar success rates in the short-term, we can say that the UPF procedure is more practical and comfortable when compared to the UPPP in the military setting.

Surgical Treatment of Obstructive Sleep Apnea: Upper Airway and Maxillomandibular Surgery

Upper airway surgery is an important treatment option for patients with obstructive sleep apnea (OSA), particularly for those who have failed or cannot tolerate positive airway pressure therapy. Surgery aims to reduce anatomical upper airway obstruction in the nose, oropharynx, and hypopharynx. Procedures addressing nasal obstruction include septoplasty, turbinectomy, and radiofrequency ablation (RF) of the turbinates. Surgical procedures to reduce soft palate redundancy include uvulopalatopharyngoplasty, uvulopalatal flap, laser-assisted uvulopalatoplasty, and RF of the soft palate with adenotonsillectomy. More significant, however, particularly in cases of severe OSA, is hypopharyngeal or retrolingual obstruction related to an enlarged tongue, or more commonly due to maxillomandibular deficiency. Surgeries in these cases are aimed at reducing the bulk of the tongue base or providing more space for the tongue in the oropharynx so as to limit posterior collapse during sleep. These procedures include genioglossal advancement, hyoid suspension, distraction osteogenesis, tongue RF, lingualplasty, and maxillomandibular advancement. Successful surgery depends on proper patient selection, proper procedure selection, and experience of the surgeon. Most surgeries are done in combination and in a multistep manner, with maxillomandibular advancement typically being reserved for refractory or severe OSA, or for those with obvious and significant maxillomandibular deficiency. Although not without risks and not as predictable as positive airway pressure therapy, surgery remains an important therapeutic consideration in all patients with OSA. Current research aims to optimize the success of these procedures by identifying proper candidates for surgery, as well as to develop new invasive procedures for OSA treatment.

Taste Disturbance After Palatopharyngeal Surgery for Obstructive Sleep Apnea

Taste disorder is a rare complication of uvulopalatopharyngoplasty, and may have a significant impact on quality of life. Herein, we report a case of obstructive sleep apnea syndrome in a 51-year-old man who experienced taste disturbance after palatopharyngeal surgery using electrocautery for developing a uvulopalatal flap. Gustatory function test using three-drop-method with solutions of highest concentration was implemented to assess the deficiency of four basic tastes. The results showed deficit of sweet taste associated with phantom of bitter taste. The patient reported constant spontaneous bitter taste and dysgeusia in sweet taste with poor quality of life at the 2-year follow-up. We suggest that patients are informed of the potential for taste impairment from palatopharyngeal surgery, as well as reducing the use of electrocautery in developing uvulopalatal flap to reduce damage to taste function.

Taste disturbance after uvulopalatopharyngoplasty for obstructive sleep apnea

This study investigated factors that may attribute to taste disturbance (TD) following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). This longitudinal intervention study enrolled 108 patients who received UPPP for OSA. Patients who reported TD in the postoperative questionnaire were examined using the three-drop-method gustatory function test (GFT). The GFT revealed that 5 patients (4.6%) reporting TD lost at least one of the four basic tastes 3 months after surgery. Deficiency of sweet sense was the most common type of TD (80%). The use of electrocautery for developing the uvulopalatal flap was the only significant predictor that may attribute to TD (odds ratio: 14.1). Repeating the GFT 9 months after operation showed a restoration of tastes in 4 patients. Development of the uvulopalatal flap using electrocautery may increase the likelihood of postoperative TD. Patients with taste disturbance after UPPP may eventually recover their taste function over time. C-4.

Simultaneous midline laser glossectomy with palatopharyngeal surgery for obstructive sleep apnoea syndrome

We investigate the outcome of performing tongue base reduction surgery and palatopharyngeal surgery in a single stage to determine whether the same-stage midline laser glossectomy (MLG) with extended uvulopalatal flap (EUPF) for obstructive sleep apnoea syndrome (OSAS) is a safe and effective procedure. Six male patients with a history of severe OSAS were recruited into the retrospective study. They were the first patients to undergo the MLG with EUPF procedure. Patients were identified to have retropalatal and hypopharyngeal sites of obstruction on the basis of fiberoptic endoscopy with Muller's manoeuvre and three-dimensional computerised tomography. No significant adverse events occurred. The follow-up polysomnography (6-month follow-up) revealed that the mean respiratory disturbance index from 50.7 to 11.6, snoring index from 230.9 to 137.3 and the minimal oxygen saturation from 76.3 to 88.8. This study confirms that the same-stage MLG with EUPF for OSAS is a safe and effective procedure.

Combined nasal–palatopharyngeal surgery for obstructive sleep apnea: Simultaneous or staged?

Conclusions. Our data indicate that surgical outcomes in a simultaneous surgery group were equivalent to those in a staged surgery group. The simultaneous type of surgery was more cost-effective in terms of total hospitalization expenses. Objective. To compare the outcomes of two types of combined nasal–palatopharyngeal surgery (simultaneous and staged) for the treatment of obstructive sleep apnea (OSA). Material and methods. A total of 85 consecutive patients were enrolled in the study. All patients had OSA and its associated symptoms, were type I according to the Fujita classification, stage 1 or 2 according to the Friedman classification and had nasal obstruction with nasal septal deviation. A modified form of uvulopalatopharyngoplasty (extended uvulopalatal flap surgery) and septomeatoplasty were used to correct upper airway abnormalities. Patients chose to have either a simultaneous (n=55) or staged (n=30) type of operation. All patients underwent overnight polysomnography at baseline and ≥6 months after completion of the operations. Surgical results (reduction of OSA), patient satisfaction, complications and hospitalization expenses were compared between the two groups. Results. The two groups comprised body mass index- and respiratory disturbance index (RDI)-matched cohorts (p>0.05). Postoperative decreases in RDI were significant in both groups (p<0.001), and postoperative RDI was indistinguishable between the two groups (p=0.77). Incidences of surgical complications, including tonsillar bleeding, nasal septal hematoma, nasal regurgitation and the sensation of a lump in the throat, were similar in the two groups (p=0.35). The simultaneous surgery group incurred lower total hospitalization expenses than the staged surgery group (p<0.001).

Three-dimensional computed tomography and polysomnography findings after extended uvulopalatal flap surgery for obstructive sleep apnea

Objectives Using both sleep physiological parameters and image data to evaluate the efficacy of extended uvulopalatal flap (EUPF) surgery in the treatment of obstructive sleep apnea (OSA). Material and methods Fifty patients with OSA underwent EUPF that consisted of bilateral tonsillectomy, dissection and removal of the submucosal adipose tissue of the soft palate and supratonsillar areas, and imbrications and repositioning of the denuded uvulopalatal flap. Polysomnography (PSG) and 3-dimensional computed tomography (3-D CT) data were obtained at baseline and 6 months postoperatively. Good response to surgery was defined as a reduction of the respiratory disturbance index (RDI) to less than 20 events/h and a greater than 50% reduction of the baseline RDI. Results Forty-two patients (84%) achieved good results. The RDI and minimal O 2 saturation improved significantly ( P < .0001) after EUPF. The postoperative 3-D CT evaluation showed a significant increase in the retropalatal space ( P < .0001). The preoperative lateral diameter of retropalatal space was predictive of the change of RDI (R 2 = 0.15, P = .05). The effect of increased retropalatal space ( r = 0.59, P = .0415) was significant in patients with baseline RDI ranged from 31 to 60 events/h. Conclusions With special emphasis on the removal of palatal fat, EUPF appeared to be effective in the reduction of sleep apnea in selected patients. 3-D CT proved that this technique was effective in widening the upper airway by relieving the retropalatal obstruction.

Same-stage palatopharyngeal and hypopharyngeal surgery for severe obstructive sleep apnea

ObjectivesTo investigate surgical outcomes with two types of combined palatopharyngeal and hypopharyngeal surgery for the treatment of severe obstructive sleep apnea (OSA).Material and methodsTwelve consecutive OSA patients with a respiratory disturbance index (RDI) >30/h and Fujita type II anatomy were enrolled. Patients were divided into two groups according to their fiberscopic manifestations. Six patients with obstruction at the uvulopalatal complex and tongue base (Group 1) were selected for extended uvulopalatal flap (EUPF) and midline laser glossectomy (MLG). EUPF and laser lingual tonsillectomy were performed in another six patients shown to have obstruction at the uvulopalatal complex and lingual tonsil (Group 2). Polysomnographic parameters included the RDI and minimal oxygen saturation (MSAT). Surgical success was defined as a postoperative RDI of <20/h and a >50% reduction in the preoperative RDI.ResultsSix months postoperatively, 5 patients (83.3%) had responded successfully in Group 1 and none in Group 2. In Group 1 the mean RDI decreased from 50.7±12.6 to 8±14.3 (95% CI 23.0−62.7; p<0.01) and MSAT increased from 76.3%±11.6% to 88.8%±3.2% (95% CI −25.9–0.87; p=0.06). There was no improvement in sleep parameters in Group 2 patients. No persistent nasal regurgitation, swallowing disturbance or change in taste was noted at 1-year follow-up in either group.ConclusionsEUPF combined with MLG improves OSA in Fujita type II patients. The hypertrophic lingual tonsil, although obscure the laryngeal structure, did not contribute significantly to OSA.

Use of Morphological Indicators to Predict Outcomes of Palatopharyngeal Surgery in Patients with Obstructive Sleep Apnea

There is no consensus on how to quantify the abnormality of upper airway structures in patients with obstructive sleep apnea (OSA). This research aimed to use morphological indicators as clinical predictors to correlate morphological stage and surgical results in OSA patients. One hundred and five patients with OSA received palatopharyngeal surgery, i.e. extended uvulopalatal flap (EUPF). Morphological indicators including modified Mallampati grade (MMP), tonsil size, and body mass index were used to stage OSA patients preoperatively. Change of respiratory disturbance index (RDI) was used to monitor change of sleep apnea events. Success rates were compared among patients of different morphological stages. One year after EUPF, the success rates of EUPF in stage I, II, and III patients were 100, 92.9 and 61.4%, respectively. Change of RDI was significantly correlated with MMP and tonsil size. MMP and tonsil size were predictive of the change of RDI (R² = 0.29). Morphological stage may serve as a reliable selection criterion for patients undergoing EUPF surgery and can significantly predict the change of sleep apnea events following EUPF surgery.

Mood improvement after surgery for obstructive sleep apnea.

Patients with obstructive sleep apnea (OSA) may experience unfavorable psychologic symptoms such as depression and anxiety. The aim of this study was to confirm this hypothesis and to investigate whether the psychologic symptoms among OSA patients can be relieved by surgical intervention. Prospective, longitudinal intervention study. The 5-Item Mental Health scale (MH-5) was used to evaluate the postoperative changes of mood after extended uvulopalatal flap (EUPF) surgery on 84 Taiwanese patients with OSA. The preoperative and postoperative MH-5 data obtained from these patients were compared with a Taiwanese population norm. Before surgery, the MH-5 scores of the OSA patients were significantly worse than the Taiwanese population norm of 72.8 (P <.0001). Postoperatively, mean MH-5 scores significantly increased from 61.8 +/- 16.0 to 70.0 +/- 15.8 (P =.0006). The effect size of this score change was 0.51, indicating a moderate degree of mood improvement. However, this score was still inferior to that of the population norm (P =.0045). The mood improvement was not significantly associated with the changes in either sleep apnea events or the level of sleepiness. Neither the changes in respiratory disturbance index (P =.4382), maximum arterial oxygen saturation (P =.4866), nor the change in Epworth Sleepiness Scale scores (P =.4951) were predictive of the MH-5 score improvement (R = 0.07). This study demonstrated that patients with OSA had a higher level of anxiety, depression, and probable behavior or personality changes than the population norm. EUPF surgery could significantly improve the mood status among OSA patients; the effect of surgery was mild but clinically relevant. However, the extent of mood improvement experienced by OSA patients receiving operations may not simply be attributable to the changes in sleep apnea events or a reduced level of sleepiness.

The Uvulopalatal Flap in Soft Palate Reconstruction

Pleomorphic adenoma involving the soft palate is uncommon. Patients with this condition can present with a mass in the oral cavity, dysphagia, and difficulty breathing. Resection of the soft palate may have a functionally detrimental effect on these patients, resulting in rhinolalia and nasal regurgitation. A patient in whom reconstruction of the soft palate defect using a uvulopalatal flap provided a simple and effective method of myomucosal tissue replacement is presented. There were no postoperative flap-related complications, rhinolalia, or regurgitation.

Uvulopalatal flap for snoring on an outpatient basis

Objective Snoring is now seen as one end of a spectrum of sleep-related breathing disorders, and in its extreme form, snoring can cause obstructive sleep apnea syndrome. Since the introduction of uvulopalatopharyngoplasty, many other procedures have been introduced to alleviate palatal abnormalities seen in patients with obstructive sleep apnea syndrome. A reversible uvulopalatal flap (UPF) achieves the same results as the uvulopalatopharyngoplasty but with less postoperative discomfort. The purpose of this study was to assess the safety and efficacy of UPF for the treatment of simple snoring on an outpatient basis. Methods UFP was performed on an outpatient basis under local anesthesia. The mucosa on the lingual surface of the uvula and soft palate was removed with cold knife dissection. The uvular tip was amputated. The uvula was reflected back toward the soft palate and sutured. Most of the patients were male with simple snoring by history and confirmed by polysomnographic study. Data on patients were compared from preoperative to postoperative assessment points. Statistic analysis was performed. Results Fifty-six patients tolerated the procedure well, and it was performed in an average of 20 minutes. Patients had a mean age of 48 years and a mean body mass index of 26.5 kg/m 2. The mean follow-up was 14 months (range, 12 to 20 months). Significant improvement was observed in snoring scale (8.2 ± 3.4 versus 2.6 ± 1.4, P < 0.05). Mean snoring index decreased from 245.8 ± 40.8 to 42.5 ± 20.7 events/hr ( P < 0.001). The correlations between the changes in the subjective and objective snoring assessments were statistically significant. Postoperative complications included transient nasal regurgitation (4%) and foreign body sensation (2%). Bleeding, dysphagia, infection, and nasopharyngeal stenosis were not observed. Most patients had mild to moderate pain (visual analog scale, ≤7) for 5 to 7 days after the procedures. The overall success rate was 88%. Conclusion Snoring, as reported by subjective and objective results, decreased after UPF. It appears to be a safe and effective procedure, which can be easily performed under local anesthesia on an outpatient basis, in carefully selected patients.