Radiofrequency tissue volume reduction of the soft palate and UPPP in the treatment of snoring

Abstract

The purpose of this study was to evaluate the efficiency of radiofrequency tissue volume reduction (RFTVR) and uvulopalatopharyngoplasty (UPPP) in the treatment of snoring in a prospective clinical trial of 79 patients consecutively undergoing surgery for snoring. Seventy-nine patients with primary snoring or mild OSAS (obstructive sleep apnea syndrome) were enrolled in this clinical trial (66 males and 13 females). According to the anatomical findings (the size of the tonsils and uvula), the patients underwent UPPP/TE of the RFTVR of the soft palate. Forty-seven patients had UPPP/TE (age 45.81+/-12.11 years; median AHI: 8; range 1-29). Thirty-two patients were treated with RFTVR of the soft palate (age 48.10+/-10.92; median AHI: 5.0; range 0-26). The average number of treatments was 2.2. All patients underwent preoperative polysomnography to exclude severe OSAS. Pre- and postoperative snoring scores were evaluated from the patients with bed partners. Postoperative follow-up data were collected at a median of 4 months after treatment; 85.1% of the UPPP group and 53.1% of the RFTVR group underwent postoperative polysomnography. Subjective snoring scores of all study participants were evaluated. Preoperatively, there was no statistically significant difference of subjective symptoms, age and BMI between the two groups. The snoring scores improved statistically significantly in both groups (P <0.001 in the UPPP group; P =0.001 in the RFTVR group). After UPPP/TE snoring improved in 37 patients (78.7%), and 29 (61.7%) thereof were free of bothersome snoring; no change was found in 9 patients (19.2%), and 1 (2.1%) worsened. In the RFTVR group, snoring improved in 15 (46.9%), and 9 (28.1%) thereof were free of bothersome snoring; no change was found in 13 patients (50%), and 1 worsened (3.1%). Preoperative AHI was statistically higher (P =0.016) and mean minimal oxygen saturation significantly lower (P =0.002) in the UPPP group. In the UPPP group AHI and HI showed statistically significant improvement postoperatively (P =0.025 and P =0.034, respectively). After RFTVR, no statistically significant change of AHI, HI or oxygen saturation was found. Besides limited mucosal erosions (15%) after RFTVR and foreign body sensations (<10%) after UPPP/TE, no side effects were observed. The success rate of RFTVR of the soft palate is lower compared to the more invasive technique of UPPP. Due to its minimally invasive character, RFTVR is suitable as first-step treatment for snoring, but patients should be counseled about possible success rates and different treatment options.

Radiofrequency surgery of the tongue base in the treatment of snoring—a pilot study

“…Apart from conservative treatment options, many different surgical procedures are offered such as laser-assisted uvuloplasty [10], uvulopalatopharyngoplasty [7,8] or radiofrequency surgery [14][15][16][17][18][19]. Initially, radiofrequency surgery of the soft palate seemed to be promising in the treatment of primary snoring, most recent results of a placebo-controlled study however showed that the reduction of snoring scores that may be achieved is only moderate [19].…”

“…Despite numerous approaches to find an adequate surgical treatment for primary snoring, no gold standard exists. Various kinds of surgical procedures are available, most of which have been developed for the treatment of obstructive sleep apnea (OSA): uvulopalatopharyngoplasty [7,8], tonsillectomy [9], laser-assisted uvulopalatoplasty [10], uvulaflap [11,12], soft palate implants [13], or radiofrequency surgery of the tongue base or the soft palate [14][15][16][17][18][19]. Some of these procedures are rather invasive and connected with side effects such as post-operative pain or bleeding or persistent swallowing difficulties [20], whereas others show only moderate efficacy [19].…”

Which Patients Can Benefit from Pillar Palatal Implant Procedure?

“…Commonly it requires general anesthesia (8). Radiofrequency and laser are alternative techniques to make up scar tissue, but these techniques may be irreversible (9)(10)(11)(12). In general, isolated palate surgery, including UPPP, is not curative for OSA in the absence of tonsil hypertrophy (13).…”

Effectiveness and Side Effects of One-Stage Laser-Assisted Uvuloplasty in Primary Rhonchopathy

“…The success rate of radiofrequency procedures on the palate is probably lower, compared to the more invasive techniques [20][21][22] . Only rarely would the results of both techniques be reported as similar [23] .…”