<p>Laser-assisted uvulopalatoplasty (LAUP) complications and side effects: a systematic review</p>

Abstract

Objective: Laser-assisted uvulopalatoplasty (LAUP) has been used as a treatment option for snoring and obstructive sleep apnea for almost three decades. It has been previously reported that some patient’s sleep-disordered breathing worsened following surgery. The aim of this paper is to further elucidate the specific complications of LAUP. Data sources: A systematic search of the electronic databases MEDLINE/PubMed, Google Scholar, and Embase. Review methods: The PRISMA statement was followed. Databases were searched from inception through September 2, 2018. The following search was applied to MEDLINE/PubMed ((laser AND uvul*) OR (LAUP) OR (LAVP) OR (laser AND (apnea OR apnoea OR sleep))). Results: Forty-two studies with a mean follow-up of 16.1 months reported complications on 3,093 total patients who underwent LAUP. The percentages and associated complications of LAUP are as follows: bleeding (2.6%), candidiasis (0.3%), dryness (7.2%), dysgeusia (0.3%), dysosmia (0.2%), globus sensation (8.2%), surgical site infection (1.3%), velopharyngeal (VP) insufficiency (3.9%), and VP stenosis (1.6%). The mean duration of patient-reported pain in studies that reported pain was 11.65 days. Only globus and VP insufficiency had a significant incidence compared with either the general population or the post-oropharyngeal surgery population with relative risks of 1.48 and 2.25, respectively. Overall, there were approximately 26 complications per 100 patients who underwent LAUP. Conclusion: LAUP is associated with a statistically significant rate of VP insufficiency and globus sensation; however, studies lack details of surgical approaches, suggesting that in a population identified as good candidates, a tissue-sparing approach may result in fewer complications.

Use of Laser in Sleep Disorders: A Review on Low Laser Uvulopalatoplasty

“…A prospective study was conducted on 40 patients by Storchi et al in 2018, where patients with snoring and sleep [16,17]. The results demonstrated that change in patient's quality of sleep is significantly increased (p < 0:0001), snoring severity is significantly improved (p < 0:0001), and immediate sensation of breathing improvement (75%) is reported in pre-and postlaser treatment [10].…”

“…A prospective study was conducted on 40 patients by Storchi et al in 2018, where patients with snoring and sleep disorders were evaluated for the effectiveness of Er:YAG (2940 nm) laser treatment sessions. After the three laser sessions, 85% of the patients self-reported to be satisfied after the treatment [ 16 , 17 ]. The results demonstrated that change in patient's quality of sleep is significantly increased ( p < 0.0001), snoring severity is significantly improved ( p < 0.0001), and immediate sensation of breathing improvement (75%) is reported in pre- and postlaser treatment [ 10 ].…”

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

“…UPPP and other previous palatal surgery techniques (e.g., LAUP, UPF) for OSA were based on ablative techniques to remove the uvula and a significant amount of soft palate tissue. Over the years, these procedures were associated with a high incidence of unfavorable postoperative complications and morbidities [13][14][15][16]. In the short and long term, the most typical problems reported in these patients were dysphagia, rhinolalia, velopharyngeal insufficiency and nasopharyngeal regurgitation, phlegm in throat, and abnormal scarring with velopharyngeal stenosis [13][14][15][16].…”

“…Over the years, these procedures were associated with a high incidence of unfavorable postoperative complications and morbidities [13][14][15][16]. In the short and long term, the most typical problems reported in these patients were dysphagia, rhinolalia, velopharyngeal insufficiency and nasopharyngeal regurgitation, phlegm in throat, and abnormal scarring with velopharyngeal stenosis [13][14][15][16]. Besides, the tissue resection required for these techniques caused a thick fibrotic scar on the palatal edge that, touching and abrading the base of the tongue, resulted in throat discomfort or foreign body sensation in the throat [17,20,21].…”

“…Another important aspect to keep in mind is postoperative pain, especially during swallowing [12][13][14]. These complications were often reported for UPPP and laser-assisted uvulopalatoplasty (LAUP) where major palate resections were performed [15,16]. On the other hand, lateral pharyngoplasty techniques would seem to have a lower incidence of these postoperative complications [12,13].…”