What is included in the preprocedural planning for uvulopalatopharyngoplasty (UPPP)?

Updated: Dec 09, 2020
  • Author: Eelam Aalia Adil, MD, MBA; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Sleep endoscopy may be used to identify the area(s) of airway collapse. This procedure involves inducing sleep pharmacologically and then performing flexible fiberoptic nasopharyngoscopy to evaluate the airway. It is usually performed in the operating room under general anesthesia.

During the procedure, the location of collapse (ie, nasopharyngeal, oropharyngeal, and/or hypopharyngeal) and the specific structures causing obstruction are identified to guide future surgical intervention. It is useful for patients undergoing primary surgery and those who have failed surgical intervention in the past.

The type of surgery offered to each patient is individualized based on the level of airway obstruction. Obstruction can occur at the nasal, retrolingual, and/or retropalatal levels. Obstruction at purely the nasal level may require a septoplasty, inferior turbinate reduction, adenoidectomy, polypectomy, and/or nasal valve reconstruction.

Airway obstruction at the retropalatal and/or retrolingual level can be approached using the protocol established by the Stanford Sleep Disorders Center. [10] In this protocol, surgery is offered in 2 phases. Phase I is further divided based on the patient’s anatomy.

Patients with type 1 anatomy have a purely oropharyngeal (ie, retropalatal) obstruction and are treated with uvulopalatopharyngoplasty. Patients with type II anatomy have oropharyngeal and hypopharyngeal obstruction and are treated with uvulopalatopharyngoplasty, genioglossus advancement, and possible hyoid myotomy. Patients with type III anatomy have hypopharyngeal obstruction alone and are treated with genioglossus advancement. Success of surgery is defined as a reduction in respiratory disturbance index by 50%. Phase II surgery consists of a maxillary-mandibular osteotomy and is offered to patients who fail phase I. The success rate is reported to be 97-100% when patients undergo both phases.


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