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Uvulopalatal Flap

Excessive soft palate tissue is a frequent cause of airway obstruction in obstructive sleep apnea. The most common procedure to treat the soft palate is a uvulopalatopharyngoplasty. Uvulopalatopharyngoplasty is a procedure in which tissue from the palate and/or the back of the throat is removed to increase airway size. However, there are potential significant complications associated with uvulopalatopharyngoplasty, such as foreign body sensation — a feeling that something is in the back of the throat while swallowing — and velopharyngeal insufficiency —  liquids or food escape into the nose while drinking or eating.

Uvulopalatal flap is a less invasive procedure that also achieves improvement of the airway. In this procedure, a small amount of tissue is removed as compared to uvulopalatopharyngoplasty. Airway improvement results from tissue rearrangement by lifting the soft palate to widen the airway. If the tonsils are still present, a tonsillectomy is always performed with the uvulopalatal flap.

This procedure is performed in a hospital surgery center under general anesthesia.

This procedure takes approximately one hour.  Overnight hospitalization is usually recommended afterward. In general, the patient can usually return to work in 10 to 14 days.

Since less tissue is removed in the uvulopalatal flap, it is associated with less pain and fewer complications than uvulopalatopharyngoplasty. However, post-operative pain can still be significant, especially when combined with a tonsillectomy. Bleeding represents another potential but uncommon complication.

This procedure is often performed in conjunction with nasal surgery, genioglossus advancement or radiofrequency reduction of the tongue in order to maximize airway improvement.

 
After Surgery
During Surgery
 
During Surgery
After Surgery

 

References:

Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C.  Overview of Phase I Surgery for Obstructive Sleep Apnea Syndrome.  Ear Nose and Throat Journal; 78(11):836-845, 1999.

Guilleminault C, Kim Y, Palombini L, Li K, Powell N.  Upper Airway Resistance Syndrome and its Treatment.  Sleep; 23:S197-S200, 2000.

Li KK, Troell RJ, Powell NB, Riley RW, Guilleminault C.  Uvulopalatopharyngoplasty, Maxillomandibular Advancement and the Velopharynx.  Laryngoscope; 111:1075-1078, 2001.

Li HY, Li KK, Chen NH, Wang PC.  Modified Uvulopalatopharyngoplasty: The Extended Uvulopalatal Flap.  American Journal of Otolaryngology; 24:311-316, 2003.

Li HY, Li KK, Chen NH, Wang CJ, Liao YF, Wang PC.  Three-Dimensional Computed Tomography and Polysomnography Findings after Extended Uvulopalatal Flap Surgery for Obstructive Sleep Apnea.  American Journal of Otolaryngology; 26:7-11, 2005.

Li KK, Powell NB, Riley RW.  Surgical Management of Obstructive Sleep Apnea.  In: Lee-Chiong T, Jr., Carskadon MA, Sateia MH, editors.  Sleep Medicine.  Philadelphia, PA, Hanley & Belfus Inc.  2001.

Li KK.  Surgical Management of Obstructive Sleep Apnea.  Clinics in Chest Medicine; 24:365-370, 2003.

Li KK.  Obstructive Sleep Apnea – Surgical Treatment.  In: Carney PR, Berry RB, Geyer JD, editors.  Clinical Sleep Disorders. Philadelphia, PA, Lippincott, Williams & Wilkins, 2004.

Li KK.  Surgical Therapy for Obstructive Sleep Apnea Syndrome.  Seminars in Respiratory and Critical Care Medicine; 26:80-88, 2005.

Li KK.  Surgical Therapy for Adult Obstructive Sleep Apnea.  Sleep Med Rev; 9(3): 201-209, 2005. 

 


 

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