Uvulopalatal Flap Research Articles

Uvulopalatal flap for snoring on an outpatient basis.

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. 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. 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%. 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.

Modified uvulopalatopharyngoplasty: the extended uvulopalatal flap

Objective: To investigate the surgical outcomes of a modified uvulopalatopharyngoplasty-extended uvulopalatal flap in the treatment of obstructive sleep apnea. Material and methods: Thirty-three consecutive patients with obstructive sleep apnea underwent extended uvulopalatal flap that consisted of bilateral tonsillectomy, dissection and removal of submucosal adipose tissue of the soft palate and supratonsillar area; imbrication; and reposition of the denuded uvulopalatal flap. Variables of polysomnography included the respiratory disturbance index, snoring index, and minimal oxygen saturation. Surgical success was defined as achieving the postoperative respiratory disturbance index to less than 20 events per hour and a greater than 50% reduction of the preoperative respiratory disturbance index. Results: Six months after operation, 27 patients (81.8%) responded successfully. The mean respiratory disturbance index decreased from 41.6 ± 28.2 to 12.5 ± 18.1( P < .0001), and the mean minimal oxygen saturation and snoring index improved significantly ( P < .0001). The postoperative sequelae were mild with 3% of occasional nasal regurgitation. Conclusions: The results in this series revealed that extended uvulopalatal flap improves obstructive sleep apnea with minimal adverse effect in selected patients, and this technique suggests a role of fat dissecting in the palatal surgery for obstructive sleep apnea.

Long-term results of uvulopalatal flap

Long-term results of uvulopalatal flap

Genioglossus advancement and hyoid myotomy under local anesthesia.

Obstructive sleep apnea syndrome (OSAS) is a common chronic illness that results in significant morbidity in many patients. Upper airway obstruction of OSAS patients occurring during sleep can appear at multiple sites, including the hypopharynx. Successful results of genioglossus advancement and hyoid myotomy with suspension (GAHM) in the treatment of hypopharyngeal obstruction have been reported when performed under general anesthesia. However, many patients have difficulty at induction of anesthesia and intubation. Patients are predisposed to specific complications, owing to anatomical abnormalities of the airway and existence of underlying syndrome. The purpose of this study was to assess the safety and efficacy of GAHM for the treatment of OSAS with the patient under local anesthesia. Thirty-one OSAS patients with hypopharyngeal obstruction underwent GAHM under local anesthesia. The inferior alveolar nerve was blocked. The osteotomized mandibular segment was advanced and turned to lock the inner surface of the mandible and geniotubercle at the outer surface. The hyoid bone was suspended to the superior aspect of the thyroid cartilage. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 46.2 +/- 5.8 years and a body mass index of 28.8 +/- 3.2 kg/m(2). Most of the patients were male. Data on patients were compared between preoperative and postoperative assessment points. Statistical analysis was performed using Student's t test. All patients tolerated the procedure well. The mean follow-up was 8 months (range, 6 to 10 months). The mean Respiratory Disturbance Index (RDI) decreased from 48.2 +/- 10.8 to 14.5 +/- 5.8, and the lowest oxygen saturation increased from 81.8 +/- 3.8% to 88.8 +/- 2.9%. The Epworth Sleepiness Scale score improved from 14.9 +/- 2.3 to 8.2 +/- 1.7 (P < 0.001), and the snoring scale improved from 8.1 +/- 0.6 to 3.4 +/- 0.9 (P < 0.001). Postoperative complications included wound dehiscence in 3%, transient dysphagia in 3%, and transient paresthesia of the lower jaw in 6%. Bleeding, infection, and airway obstruction were not observed. Most patients had mild-to-moderate pain (visual analog scale, </=7) for 5 to 7 days after procedures. Responders were defined as OSAS patients who had a reduction in the RDI of >/=50% and an RDI of </=20 after surgery. By these criteria, 70% of the patients were regarded as having responded to GAHM. Significant reduction in RDI and clinical improvements in snoring and sleepiness were observed after GAHM. It appears to be a safe, inexpensive, and effective procedure that can be performed under local anesthesia with a low chance of complications in carefully selected OSAS patients.

Genioglossus advancement and hyoid myotomy under local anesthesia

Obstructive sleep apnea syndrome (OSAS) is a common chronic illness that results in significant morbidity in many patients. Upper airway obstruction of OSAS patients occurring during sleep can appear at multiple sites, including the hypopharynx. Successful results of genioglossus advancement and hyoid myotomy with suspension (GAHM) in the treatment of hypopharyngeal obstruction have been reported when performed under general anesthesia. However, many patients have difficulty at induction of anesthesia and intubation. Patients are predisposed to specific complications, owing to anatomical abnormalities of the airway and existence of underlying syndrome. The purpose of this study was to assess the safety and efficacy of GAHM for the treatment of OSAS with the patient under local anesthesia. Thirty-one OSAS patients with hypopharyngeal obstruction underwent GAHM under local anesthesia. The inferior alveolar nerve was blocked. The osteotomized mandibular segment was advanced and turned to lock the inner surface of the mandible and geniotubercle at the outer surface. The hyoid bone was suspended to the superior aspect of the thyroid cartilage. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 46.2 +/- 5.8 years and a body mass index of 28.8 +/- 3.2 kg/m(2). Most of the patients were male. Data on patients were compared between preoperative and postoperative assessment points. Statistical analysis was performed using Student's t test. All patients tolerated the procedure well. The mean follow-up was 8 months (range, 6 to 10 months). The mean Respiratory Disturbance Index (RDI) decreased from 48.2 +/- 10.8 to 14.5 +/- 5.8, and the lowest oxygen saturation increased from 81.8 +/- 3.8% to 88.8 +/- 2.9%. The Epworth Sleepiness Scale score improved from 14.9 +/- 2.3 to 8.2 +/- 1.7 (P < 0.001), and the snoring scale improved from 8.1 +/- 0.6 to 3.4 +/- 0.9 (P < 0.001). Postoperative complications included wound dehiscence in 3%, transient dysphagia in 3%, and transient paresthesia of the lower jaw in 6%. Bleeding, infection, and airway obstruction were not observed. Most patients had mild-to-moderate pain (visual analog scale, </=7) for 5 to 7 days after procedures. Responders were defined as OSAS patients who had a reduction in the RDI of >/=50% and an RDI of </=20 after surgery. By these criteria, 70% of the patients were regarded as having responded to GAHM. Significant reduction in RDI and clinical improvements in snoring and sleepiness were observed after GAHM. It appears to be a safe, inexpensive, and effective procedure that can be performed under local anesthesia with a low chance of complications in carefully selected OSAS patients.

Hyoid myotomy with suspension under local anesthesia for obstructive sleep apnea syndrome.

Upper airway obstruction of patients with obstructive sleep apnea syndrome (OSAS) occurring during sleep can appear at multiple sites. Successful results of hyoid myotomy with suspension (HM) in the treatment of hypopharyngeal obstruction performed under general anesthesia have been reported. However, many OSAS patients have difficulty at the induction of anesthesia and intubation. They are predisposed to specific complications owing to anatomical abnormalities of the airway and the existence of an underlying syndrome. The purpose of this study was to assess the safety and efficacy of HM for the treatment of OSAS under local anesthesia. Thirty-two OSAS patients with hypopharyngeal obstruction underwent HM under local anesthesia. The hyoid bone was suspended to the superior aspect of the thyroid cartilage. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 39.2+/-5.7 years and a body mass index of 29.3+/-2.4 kg/m(2). Data on the patients were compared from preoperative to postoperative assessment points. Statistical analysis was performed using the Student's t-test. All patients tolerated the procedure well. The mean follow-up was 8.1+/-2.4 months (range 5 to 10 months). The mean RDI decreased from 44.5+/-8.7 to 15.2+/-5.6 ( P<0.001), and the lowest oxygen saturation increased from 82.1+/-3.7% to 87.9+/-2.7% ( P<0.01). The Epworth sleepiness scale improved from 14.1+/-2.2 to 8.2+/-2.3 ( P<0.01), and the snoring scale improved from 8.5+/-1.8 to 3.5+/-1.7 ( P<0.001). Postoperative complications included transient dysphagia in 3% of the patients and transient aspiration in 9%. Bleeding, infection and airway obstruction were not observed. Most patients had mild to moderate pain (visual analog scale <or=7) for 5 to 7 days after the procedures. Responders were defined as OSAS patients who had a reduction in the respiratory disturbance index (RDI) of 50% or more and a RDI of 20 or less after surgery. By these criteria, 78% of the patients were regarded as having responded to HM. A significant reduction in the RDI and clinical improvements were observed after HM. It appears to be a safe, inexpensive and effective procedure that can be performed under local anesthesia with a low probability of complications.

Modified uvula flap in therapy of sleep-related breathing disorders

Velopharyngeal incompetence is a well described complication of uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea. A new uvulopalatal flap technique (UPF), first presented by Powell in 1996 was now modified by our team. The new technique intends to lateralize the posterior faucial pillars as the UPPP, entirely sparing uvulopalatal muscles. No statistical difference existed in change of AHI before and after surgery in all patients even though 14 patients had a statistically significant decrease in AHI (pre 19.2 +/- 19.6; after 8.2 +/- 9.8; p < 0.05). Snoring decreased clearly (p < 0.05) from 49.4% to 25.9%.

The uvulopalatal flap for reconstruction of the soft palate.

To determine the indications, complications, and outcomes of the uvulopalatal flap in the reconstruction of defects of the soft palate. Retrospective review. Patient data were obtained from the hospital records of 18 patients who had soft palate defects reconstructed with the uvulopalatal flap over a 5-year period at a tertiary academic medical center. Eleven patients had the uvulopalatal flap as the sole method of reconstruction, whereas this flap was used in combination with a radial forearm free flap, pectoralis flap, and skin graft in 4, 2, and 1 patients, respectively. All flaps were successful in soft palate reconstruction. One flap was successfully revised after additional tumor resection. A partial flap dehiscence occurred in one patient and healed uneventfully. Speech and swallowing function was dependent on initial tumor stage and the scope of tumor resection. The uvulopalatal flap is a simple and effective method of soft palate reconstruction either alone or in combination with other methods of reconstruction for selected oropharyngeal defects.

The uvulopalatal flap

A number of variations of the uvulopalatopharyngoplasty have been described in the literature for the treatment of sleep-disordered breathing. The most widely performed of these procedures in the office setting is the laser-assisted uvulopalatoplasty. The laser-assisted uvulopalatoplasty, while technically easy to perform, has several drawbacks. The procedure requires the availability of a laser, and it is generally not performed in one session, but is staged over several months in multiple procedures. The following article describes a relatively new palatal technique, a one-stage uvulopalatal flap, which can be performed in the outpatient setting under local anesthesia or under general anesthesia in the operating room. It does not require the purchase of any additional equipment, and is easy to perform. It also offers potential advantages over the traditional uvulopalatopharyngoplasty in maintenance of palatal dynamics, lessened chance of scar contracture, reversibililty, and lessened pain. A number of variations of the uvulopalatopharyngoplasty have been described in the literature for the treatment of sleep-disordered breathing. The most widely performed of these procedures in the office setting is the laser-assisted uvulopalatoplasty. The laser-assisted uvulopalatoplasty, while technically easy to perform, has several drawbacks. The procedure requires the availability of a laser, and it is generally not performed in one session, but is staged over several months in multiple procedures. The following article describes a relatively new palatal technique, a one-stage uvulopalatal flap, which can be performed in the outpatient setting under local anesthesia or under general anesthesia in the operating room. It does not require the purchase of any additional equipment, and is easy to perform. It also offers potential advantages over the traditional uvulopalatopharyngoplasty in maintenance of palatal dynamics, lessened chance of scar contracture, reversibililty, and lessened pain.

Reconstruction of the soft palate by uvulopalatal flap.

Surgical removal of the soft palate in cases of neoplastic disease has a functionally detrimental effect on the patient, resulting in rhinolalia and nasal regurgitation. The authors describe their original surgical technique for repairing the lateral soft palate defect using a uvulopalatal flap. The flap is readily available and the procedure is single staged and without sequela. The aim of this reconstructive procedure is to obtain a diminished soft palate defect by primary surgery. In five patients who underwent a partial excision of the soft palate, the surgical defect was corrected at the time of initial surgery by a uvulopalatal flap. In this technique, the surface of the defect was diminished, postoperative rhinolalia and regurgitation were unremarkable, and sometimes an obturator was obviated. Using a local myomucosal flap, the procedure is simple, safe, and effective.

A reversible uvulopalatal flap for snoring and sleep apnea syndrome.

Velopharyngeal incompetence (VPI) is a recognized complication of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea. A new uvulopalatal flap (UPF) technique that modifies the UPPP and reduces this risk is presented. The technique achieves the same anatomic results as the UPPP but is reversible. To evaluate clinical outcomes of this new procedure, selected variables were compared in patients who underwent UPPP and UPF procedures. Eighty patients were examined (59/80 UPF, 21/80 UPPP) in a prospective and consecutive manner. Subjects underwent polysomnography and extensive airway evaluations. The characteristics of all patients, at baseline, were evaluated. The study variables included age, sex, body mass index (BMI), palatal length (PNS P) in millimeters, respiratory disturbance index (RDI), lowest oxygen saturation during sleep and a subjective snoring scale. Sixty-seven of the 80 patients underwent simultaneous hypopharyngeal surgery. Data were analyzed with a SAS program. No statistical difference existed between groups. The postoperative character of the palate and the change in snoring scores were the same in all patients (p = 0.584). A positive correlation existed between improvement in the snoring score and the amount of tissue removed or repositioned in the patients treated with UPF (correlation coefficient = 0.370, p = 0.004). In contrast, there was a negative correlation in the UPPP group for the same parameters (correlation coefficient = -0.195, P = 0.409). This suggests there was a difference between these two groups despite the fact that the baseline and postoperative lengths, as well as tissue removed or repositioned, were equivalent. This further suggests that the UPF may reduce snoring to a greater extent than the UPPP. No significant complications were seen in either group. There was no evidence of VPI, even in the early postoperative period. The new reported procedure is reversible and conservative and reduces the risk of VPI. Snoring is improved, which is consistent with a decrease in airway resistance or obstruction.