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Uvulopalatopharyngoplasty

(UPPP; UP3)

Definition

Uvulopalatopharyngoplasty (UPPP) is surgery to remove excess tissue from the back of the mouth and the throat. The tonsils and adenoids, if present, may also be removed.
The Mouth and Throat
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Reasons for Procedure

UPPP is most often done to treat sleep apnea which causes pauses in breathing during sleep. Rarely, it may be done to treat excessive snoring. Muscles in the back of your throat relax when you sleep. When the muscles relax, the soft tissue they support can collapse into the airway. The narrowed airway can cause snoring and sleep apnea.
UPPP removes excess soft tissue to keep the airway open during sleep. It may be done if other methods of controlling your condition have not been helpful.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Excess bleeding
  • Adverse reaction to anesthesia such as lightheadedness or wheezing
  • Nausea and vomiting
  • Infection
  • Vocal changes
  • Swallowing problems
  • Reduced sense of smell
  • Scar tissue, which may lead to a nasal blockage
Some patients do not respond to this surgery. Other methods to control sleep apnea may need to be continued after the procedure.
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:
  • Smoking
  • Drinking
  • Chronic diseases, such as diabetes or obesity
This surgery is more successful in those who maintain a healthy weight.

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam
  • Blood and urine tests
  • Imaging tests
  • Sleep studies
  • A nasopharyngoscopy to view the back of your nose and throat
Before arriving for surgery:
  • Arrange for someone to drive you home from the hospital.
  • Do not eat or drink anything after midnight the night before the procedure.
Certain medications may cause complications during the procedure or recovery. These medications may need to be stopped up to one week before the procedure. Talk to your doctor before the procedure about all medications, herbs, and supplements you are taking.

Anesthesia

General anesthesia will be used. It will block pain and keep you asleep through the procedure.

Description of the Procedure

The doctor can gain access to the area through the mouth. Incisions will be made to remove excess tissue. Your tonsils and adenoids may also be removed at this time. A special tool with electrical current or clamps and ties will be used to stop bleeding at the site. Sutures may also be used to close some incisions.

Immediately After Procedure

After the operation, you will be taken to the recovery room for observation.

How Long Will It Take?

The length of the procedure will depend on the amount of work you have.

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. After surgery, you may have severe pain. Pain can be managed with medications.

Average Hospital Stay

This is done in a hospital. The usual length of stay is 1 day to make sure you can swallow. If you have any problems, you may need to stay longer. In other cases, you may not have to stay overnight.

Post-procedure Care

At the Hospital
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
  • Pain medications
  • Antibiotics to prevent infection
  • Steroids to reduce swelling
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
There are also steps you can take to reduce your chances of infection, such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
At Home
It may take a few days before you are comfortable enough to return to your normal diet or return to work.

Call Your Doctor

Call your doctor if any of these occur:
  • Signs of infection, including fever and chills
  • Pain that you cannot control with the medications you were given
  • Excess bleeding or drainage from the incision sites
  • Persistent nausea or vomiting
  • Signs of dehydration, such as not urinating for 8 or more hours
  • Difficulty breathing
  • New or worsening symptoms
If you think you have an emergency, call for emergency medical services right away.

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org
American Sleep Apnea Association
http://www.sleepapnea.org

CANADIAN RESOURCES

Canadian Sleep Society
http://www.canadiansleepsociety.ca
Canadian Society of Otolaryngology
http://www.entcanada.org

References

Uvulopalatopharyngoplasty (UP 3). Ear, Nose, and Throat Center of Utah website. Available at: http://entcenterutah.com/files/Uvulopalatopharyngoplasty-post-op-instructions.pdf. Accessed May 5, 2014.
Varieties of OSA surgery. American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/treat/treatment-options/surgery.html. Accessed May 5, 2014.
Khan A, Ramar K, Maddirala S, Friedman O, Pallanch JF, Olson EJ. Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: The Mayo Clinic experience. Mayo Clin Proc. 2009;84(9):795-800.

Revision Information

Article written by Buck D