Uvulopalatopharyngoplasty UPPP for Obstructive Sleep Apnea

This is the traditional UPPP technique for improving the airway at this level. There are many modifications of this technique. Laser removal of tissues commonly called a laser assisted palatopharyngoplasty (LAUP) gained popularity some years back since it could be done as an outpatient or office procedure. Due to excessive pain and multiple treatments, this technique is used less commonly. Radiofrequency (TCRF) has all but replaced this technique for snoring.

In addition, we developed a palatal flap procedure that creates a flap of the uvula and free edge of the soft palate. This limits pain and there is no free wound edge, as is seen in the traditional UPPP or LAUP. In fact the flap may be taken down within a week if any problems are seen with speech or swallowing. This is a rare unexpected outcome of UPPP but very important if it happens to you. However, decreased pain and the reversibility of this technique is a major plus for the technique.

Please click below to review our investigation on this technique.**

• Powell N, Riley R, Guilleminault C, Troell R: A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep 1996;19(7):593-599

What is Uvuloplatopharngoplasty (UPPP)?

Uvulopalatopharyngoplasty (also frequently referred to as UPPP or UP3) is a surgical procedure that removes or repositions excess tissue from the soft palate and uvula. This excess tissue may cause obstruction of the airway, causing snoring and in some patients obstructive sleep apnea This technique will focus on shortening of the uvula (the small tissue that hangs at the back of the throat), a portion of soft palate), and may also include the tonsils, and in children the adenoids.

Different Approaches to UPPP Surgery

Some patients undergo UPPP surgery as a standalone operation, and others have the UPPP surgery as a first step in a phased surgical plan where other procedures at different levels of the airway are performed as a comprehensive remedy for more complicated obstructive sleep apnea syndrome cases.

There are different techniques to performing a UPPPprocedure. Laser removal of tissues called a laser assisted palatopharyngoplasty (LAUP) gained popularity some years back since it could be done as an outpatient or office procedure. Due to excessive pain and the frequent necessity for multiple treatments, this technique is used less commonly today. Radiofrequency (TCRF) has all but replaced this technique for snoring.

California Sleep Institute surgeons Drs. Robert Riley and Nelson Powell previously developed a modified UPPP procedure called the uvulo palatal flap technique which creates a tissue flap of the uvula and free edge of the soft palate. This approach to UPPP reduces pain and allows the the procedure to be reversed in the early stages of healing (1-10 days) This is rarely used but is very valuable for professionals such as singers that this possibility exists. This groundbreaking article has been cited by over 50 articles in the years since its publication. (reference this to journal Sleep.

Powell N, Riley R, Guilleminault C, Troell R: A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep 1996;19(7):593-599

What Should I Expect After the UPPP Technique?

It can be very uncomfortable for the first 2-3 days and each day the discomfort decreases. Liquid pain medicine can control this discomfort and we usually expect that pain medications can taper off in 2-7 days. If tonsils are also included it is well known to be associated with more discomfort and the healing process is slightly prolonged. We suggest liquids, to incluce soups, for the first 2 days and then a soft diet for the next 1-2 weeks. Routine office visits are recommended to reassure and support the patients concerns and questions.

Who is qualified to perform UPPP Techniques?

The California Sleep Institute is a leading global center providing specialty surgical and medical services in the area of craniofacial surgery, evaluation and treatment of obstructive breathing disorders to include Obstructive Sleep Apnea Syndrome (OSAS), Upper Airway Resistance Syndrome and snoring, diagnosis and treatment of facial deformities, and management of sinus disease, as well as other head and neck related conditions. Dr. Robert Riley and Nelson Powell together have over fifty years of surgical experience, and they have performed thousands of successful craniofacial and airway examinations and surgeries. Their entire careers have been completely dedicated to the medical and surgical management of sleep disorders, with an extensive published research bibliography. Other physicians at the California Sleep Institute include Dr. Jerome Hester, Dr. Don Sesso and Dr. Stephen Schendel, each a board-certified sleep surgeon.

Together with its sister organizations the California Ear Institute and the Sinus Institute at CEI, these three organizations can provide an integrated approach to solving sleep/sinus/hearing/ balance disorder issues unparalleled anywhere in the world.
Selection of an experienced surgeon at a state-of-the-art facility with the most up-to-date training is essential to having the best chance of a good outcome with your uvulopalatopharyngoplasty (UPPP) surgery.

For a detailed treatment rationale indications and outcomes, continue to MANAGEMENT OF SLEEP-DISORDERED BREATHING