Sleep Apnea

What Are the Drawbacks to Uvulopalatopharyngoplasty?

Posted on 24. Dec, 2009 by admin in Treatments for Obstructive and Mixed Apneas

Compared with many surgical procedures, uvulopalatopharyngoplasty is not a particularly risky kind of surgery. It does not involve any large arteries or nerves. It may be performed as outpatient surgery in healthy, uncomplicated cases. A hospital stay of one or two days may be necessary for some patients.

As mentioned previously, the greatest risk probably is from the anesthesia. The more narrow the airway, the greater the risk from preoperative medications, from anesthetics, and from painkillers and sedatives given immediately after the operation.

The reason for this increased risk is that anesthetics and some other drugs interfere with the breathing reflexes. If you have sleep apnea, you already have breathing reflexes that may not operate quite normally. This means that you are at somewhat greater than normal risk from anesthesia. This breathing abnormality, coupled with existing apnea, possible throat obstruction from postoperative swelling, and perhaps pain medication could add up to serious complications.

Pain is another consideration with UPPP. People who have had UPPP report that the pain after the operation is very severe — more painful than expected (e.g., more painful than a tonsillectomy). Severe pain can last as long as a week.

All patients report difficulty with swallowing after surgery. The removal of the uvula at the back of the mouth cavity makes it easier for material from the mouth to be pushed up into the back of the nasal cavity during swallowing. This is a common problem for the first two weeks after surgery, but it should correct itself with time, particularly if the surgeon is skilled and experienced with the procedure. A few people continue to have swallowing problems. However, most who do have a little difficulty swallowing find that they overcome the problem with some practice and if they eat properly.

There have been reports of airway obstruction becoming worse or more difficult to treat with CPAP following UPPP.

Why Have Uvulopalatopharyngoplasty If the Odds Are Poor?

Even if the chances of being helped enough not to require further treatment are 50 percent to 60 percent, you may prefer taking a chance in the hope of avoiding other treatments, such as CPAP, oral appliances, or other surgeries.

UPPP has a very low risk when performed on patients who have been carefully tested at a good sleep center, and when the surgery is performed by an experienced ENT surgeon. (For example, at Providence Medical Center in Seattle there never has been a surgical fatality or serious complication.)

How Can You Arrange for Uvulopalatopharyngoplasty?

It is not wise to have UPPP as a treatment for sleep apnea until you have been thoroughly examined by a physician who understands the causes of sleep apnea and knows how to weigh the benefits against the risks in your particular case. The sleep specialist, in turn, can refer you to a surgeon who is experienced with UPPP if you appear to be a good candidate for successful treatment by this procedure.

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