The Effect of Uvulopalatopharyngoplasty with Tonsillectomy in Patients with Obstructive Sleep Apnea

Baradaranfar, Mohammad Hossein; Edalatkhah, Mohsen; Dadgarnia, Mohammad Hossein; Atighechi, Saeid; Behniafard, Nasim; Mirvakili, Abbas; Halvani, Abolhasan; Meybodi, Tohid Emami

doi:10.1007/s12070-014-0735-1

Cited by 11 publications

(8 citation statements)

References 25 publications

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“…We read with great interest the uvulopalatopharyngoplasty (UPPP) article by Baradaranfar et al [1]. and the accompanying editorial, written by Mantovani et al [2].…”

Section: Editorialmentioning

confidence: 99%

Tissue-Sparing Uvulopalatopharyngoplasty for OSA: Conservative, Compassionate and Possibly just as Effective

Camacho

Certal

Modi³

et al. 2015

Indian J Otolaryngol Head Neck Surg

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A common surgical treatment for obstructive sleep apnea (OSA) is uvulopalatopharyngoplasty (UPPP). Unfortunately, traditional UPPP can cause a foreign body sensation, chronic discomfort and in rare cases, nasopharyngeal stenosis or velopharyngeal insufficiency. Modifications to traditional UPPP have been developed over the years to help decrease side effects, while trying to maintain or improve OSA outcomes. Conservative, tissue-sparing UPPP techniques include preservation of soft palate tissues (muscle and/or mucosa), avoidance of plication or conservative plication of the uvula, partial instead of complete uvulectomy, and suture plication of the palatopharyngeussuperior pharyngeal constrictor-palatoglossus muscles with complete preservation of surrounding tissues after tonsillectomy.

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“…We read with great interest the uvulopalatopharyngoplasty (UPPP) article by Baradaranfar et al [1]. and the accompanying editorial, written by Mantovani et al [2].…”

Section: Editorialmentioning

confidence: 99%

Tissue-Sparing Uvulopalatopharyngoplasty for OSA: Conservative, Compassionate and Possibly just as Effective

Camacho

Certal

Modi³

et al. 2015

Indian J Otolaryngol Head Neck Surg

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“…This paper gave us the impetus to reflect about UPPP, which is one of the most frequently performed procedures for snoring and OSAS in adults with retro-palatal obstruction, although reported results of UPPP are not brilliant [1,2]. UPPP has a reported success rate of approximately 40-60 % for improving mild to moderate OSA [3].…”

Section: Dear Editormentioning

confidence: 99%

“…In the era of the mini-invasive/ conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS, with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, we believe that we should re-evaluate the role of these procedures involving the resection of palatal/pharyngeal muscles and uvula.We read with great interest the recent article from Baradaranfar et al [1] describing the effectiveness of uvulopalatopharyngoplasty (UPPP) in treatment of patients with obstructive sleep apnea syndrome (OSAS). This paper gave us the impetus to reflect about UPPP, which is one of the most frequently performed procedures for snoring and OSAS in adults with retro-palatal obstruction, although reported results of UPPP are not brilliant [1,2].…”

mentioning

confidence: 99%

“…We read with great interest the recent article from Baradaranfar et al [1] describing the effectiveness of uvulopalatopharyngoplasty (UPPP) in treatment of patients with obstructive sleep apnea syndrome (OSAS). This paper gave us the impetus to reflect about UPPP, which is one of the most frequently performed procedures for snoring and OSAS in adults with retro-palatal obstruction, although reported results of UPPP are not brilliant [1,2].…”

mentioning

confidence: 99%

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Should We Stop Performing Uvulopalatopharyngoplasty?

Mantovani

Rinaldi

Salamanca³

et al. 2014

Indian J Otolaryngol Head Neck Surg

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Uvulopalatopharyngoplasty (UPPP) is still one of the most frequently performed procedures for snoring and obstructive sleep apnea syndrome (OSAS) in adults, with unsatisfactory results. In the era of the mini-invasive/ conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS, with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, we believe that we should re-evaluate the role of these procedures involving the resection of palatal/pharyngeal muscles and uvula.We read with great interest the recent article from Baradaranfar et al. [1] describing the effectiveness of uvulopalatopharyngoplasty (UPPP) in treatment of patients with obstructive sleep apnea syndrome (OSAS). This paper gave us the impetus to reflect about UPPP, which is one of the most frequently performed procedures for snoring and OSAS in adults with retro-palatal obstruction, although reported results of UPPP are not brilliant [1,2]. UPPP has a reported success rate of approximately 40-60 % for improving mild to moderate OSA [3]. Värendh et al. reported that almost 50 % of patients operated with UPPP are not satisfied with the result of the operation after 20 years, and one-third uses CPAP at the follow-up [4]. Furthermore this ''resective'' technique, in which the uvula, part of the soft palate and lateral pharyngeal walls are excised, is associated with long-term side-effects (velopharyngeal insufficiency, dysphagia, persistent dryness, globus sensation, voice changes, nasopharyngeal stenosis) persisting after UPPP in 58 % of the patients [2]. Due to resulting leaks and mouth dryness, UPPP is also considered as a risk factor for CPAP non-compliance.In the era of the mini-invasive/conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS [5], with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, are we still allowed to propose the resection of palatal/pharyngeal muscles and uvula?The role of the excessive collapsibility of the lateral pharyngeal walls has become increasingly considered in the genesis of retropalatal OSAS [5]. Therefore the recent evolution of OSAS surgery has been focusing on the goal of obtaining the expansion and stabilization of the pharyngeal airspace through the reduction of the lateral

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“…El tratamiento quirúrgico para el ronquido y el SAHOS tiene como objetivo aumentar el área de sección transversal de la vía aérea superior y eliminar tejidos obstructivos 8 . Dentro de las alternativas quirúrgicas, la uvulopalatofaringoplastía (UPPP, por sus siglas en inglés) es uno de los procedimientos más ampliamente difundidos, demostrando éxito en la reducción de los síntomas y mejoría en la calidad de vida 2,3,9,10 , ya que la mayoría de estos pacientes cursa con algún grado de estrechamiento de la vía aérea en el nivel velofaríngeo 9 . Sin embargo, su utilidad continúa siendo controversial, particularmente en el SAHOS moderado-severo, debido a la falta de estudios controlados y criterios estandarizados para definir su eficacia 2,9,10 , por lo que la aplicación de presión positiva continua en la vía aérea (CPAP) es el tratamiento de elección en esta entidad 1-10 .…”

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