UVULOPALATOPHARYNGOPLASTY (UPPP)
▲ GENERAL INFORMATION
The uvula is the structure that is located at the back of
the soft palate (the floppy part at the back of the roof
of the mouth) and hangs down at the back of your
throat. The uvula is about 1 inch long, but in some
people it is a lot longer and thicker. The tonsils in
some adults can be quite enlarged owing to recurrent
infections through the years. In addition, the soft palate
can also be elongated and somewhat flabby. These excess throat tissues can be responsible for several problems.
Soft
palate
COMMON SIGNS AND SYMPTOMS
• Snoring: These excess tissues in the back of the
throat vibrate as the air to and from the lung passes
by it. This produces loud snoring.
• Obesity can increase the amount of fatty tissue in
your neck, throat, and chin.
• Facial and jaw structure can add to the crowding of
all the internal throat tissues.
• A crooked nasal septum can prevent normal flow of
air through the nose at night, causing mouth
breathing.
• Breath-holding: This condition can progress over the
years to the point where it causes gagging, gasping,
and breath-holding (called apnea) while you sleep.
Apnea can be dangerous because without regular
breathing, your body does not get all the oxygen it
needs. Also, the gasping often wakes you from a
deep stage of sleep many times through the night so
that you wake up feeling tired.
Uvula
Tonsil
DIAGNOSIS
• The loud snoring is most often recognized by the
spouse or bed partner of the patient.
• Often a tape recording of the snoring will also
capture the gasping and the apnea.
• A sophisticated sleep study may be done at home or
in a laboratory to monitor the level of oxygen in the
blood, the heart rhythm, and brain activity.
● TREATMENT
• In continuous positive airway pressure (CPAP), a
machine gently pushes air through nose plugs or a
face mask. If properly used every night, the CPAP
machine can force air through the crowded tissue to
allow you to breathe normally, quietly, and without
apnea.
• For many patients, an operation is advisable:
• Sometimes removal of the uvula alone is all that is
needed.
• For patients with large tonsils and a sagging palate,
a tonsillectomy and a uvulopalatopharyngoplasty
(UPPP) are necessary. UPPP involves removing the
uvula and the sagging palate (Fig. 1).
• Often UPPP can be done in the office with a laser
under local anesthesia, or it may be necessary for
the patient to be asleep. The advantages and
q Copyright 1999 by WB Saunders Company. All rights reserved.
Figure 1. A, Typical normal anatomy. B, Thickened, wide uvula
and large, floppy soft palate. The tonsils are also enlarged. In a
UPPP, the uvula and a portion of the soft palate are removed
(dashed line). The enlarged tonsils are also removed at this time
to tighten up the redundant tissue.
•
disadvantages of each technique will be discussed
with you.
After careful consideration of all factors, the recomUVULOPALATOPHARYNGOPLASTY (UPPP) 661
mendation is that you have a UPPP under general anesthesia. The need for a tonsillectomy along with the
UPPP will be discussed with you beforehand.
PREOPERATIVE PREPARATION
• You will have an examination of your blood, urine,
heart (EKG), and lungs (chest x-ray).
• Do not eat or drink anything for 8 hours before the
operation.
■ OPERATION
• You will be asleep for the operation.
• The operation usually takes about 1 hour.
POSTOPERATIVE CARE
• You will be taken to a recovery room and observed.
When your blood pressure, pulse, and breathing are
stable and you are completely alert, you should be
able to go home that same day with a responsible
adult.
• Pain will be controlled with medicine.
• The diet for the first 10 days should be liquids or
soft foods that don’t require much chewing.
• The stitches will dissolve or fall out by themselves in
about 2 weeks.
• As with any operation, complications are always
662 UVULOPALATOPHARYNGOPLASTY (UPPP)
possible. With this type of operation, they can
include bleeding, infection, and possibly others.
• Arrangements will be made for your medicine and
follow-up office visit.
✚ HOME CARE
• You may walk about as you wish, even climb stairs,
but don’t overdo things.
• A small amount of blood-tinged saliva is common
and may be noticed for a few days.
• Drink slowly and carefully for the first few days.
Sometimes if you drink fast, liquids may come out of
your nose. If this persists, be certain to mention it
during your follow-up office visit.
• Most patients notice an immediate decrease in
snoring and improvement in sleep. However, if after
4 to 6 weeks your previous symptoms return, be
certain to mention this to us.
• Avoid doing a lot of talking for the first few days as
this may put too much strain on your throat sutures.
• You may go back to work when you feel up to it.
✆ CALL OUR OFFICE IF
•
•
•
•
You
You
You
You
are having bleeding or cough up blood clots.
develop a temperature higher than 1007F.
have sleep apnea.
have any questions.
q Copyright 1999 by WB Saunders Company. All rights reserved.