Uvulopalatopharyngoplasty (UPPP)
Palate surgery; Uvulopalatal flap procedure; UPPP; Laser-assisted uvulopalaplasty; Radiofrequency palatoplasty; Velopharyngeal insufficiency - UPPP; Obstructive sleep apnea - uvulopalaplasty; OSA - uvulopalaplasty
Uvulopalatopharyngoplasty (UPPP) is surgery to open the upper airways by taking out extra tissue in the throat. It may be done alone to treat mild obstructive sleep apnea or snoring or with other procedures to treat moderate obstructive sleep apnea (OSA).
Description
UPPP removes soft tissue at the back of the throat. This includes:
- All or part of the uvula (the soft flap of tissue that hangs down at the back of the mouth).
- Parts of the soft palate and tissue at the sides of the throat.
- Tonsils and adenoids, if they are still there.
Why the Procedure Is Performed
Your health care provider may recommend this surgery if you have mild OSA.
- Try lifestyle changes first, such as weight loss or changing your sleep position.
- Most experts recommend trying to use CPAP, nasal expanding strips, or an oral device to treat OSA first, before considering surgery.
Your provider may recommend this surgery to treat severe snoring, even if you do not have OSA. Before you decide about this surgery:
- See if weight loss helps your snoring.
- Consider how important it is to you to treat snoring. The surgery does not work for everyone.
- Make sure your insurance will pay for this surgery. If you do not also have OSA, your insurance may not cover the surgery.
Sometimes, UPPP is done along with other more invasive surgeries to treat severe OSA.
Does your significant other complain that your snoring wakes them up during the night or keeps them from getting to sleep in the first place? Do they poke you, waking you up because sometimes they're afraid you stopped breathing? If so, you may have a condition called obstructive sleep apnea. When you have sleep apnea, the flow of air to your lungs pauses or decreases while you sleep. This happens because your airway has become narrow or blocked. While you sleep, all of the muscles in your body become more relaxed, including the muscles that help keep your airway open, allowing air to flow freely to your lungs. Normally, your upper throat still remains open enough during sleep to let air easily pass by. Some people, however, have a narrowing throat area. When the muscles in their upper throat relax during sleep, their breathing can stop, often for more than 10 seconds. When breathing stops, it's called apnea. Often you're not aware that you stopped breathing during sleep. But you may wake up not-refreshed, and feel drowsy and tired during the day. If you have this condition, your doctor will perform a physical exam, carefully checking your mouth, neck, and throat. You may take a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits. If your doctor suspects you do have sleep apnea, you make take a polysomnogram, a sleep study that monitors you while you sleep. Once your doctor diagnoses sleep apnea, treatment will focus on keeping your airway open so that you breathe better while you sleep. Lifestyle steps can help. You can avoid alcohol or sedatives, and not just at bedtime, avoid sleeping on your back, and try to lose weight if you need to. And, exercise can help, even in the absence of weight loss. Your doctor can also prescribe a positive airway pressure using a machine, with a tight-fitting face mask, that pumps slightly pressurized air into your mouth during your breathing cycle. This keeps your windpipe open and prevents apnea episodes. Some people need to wear dental devices that keep their jaw forward during sleep. If lifestyle changes and devices don't help, surgery may be an option. Untreated sleep apnea, however, may lead to or worsen heart disease. Most people with sleep apnea who get treatment have less anxiety and depression than they did before. They often perform better at work or school, too. Naturally, having less daytime sleepiness can lower your risk for accidents at work, while you drive and give you more energy throughout the day.
Risks
Risks of anesthesia and surgery in general are:
- Reactions to medicines or breathing problems
- Bleeding, blood clots, or infection
Risks of this surgery are:
- Damage to the muscles in the throat and soft palate. You may have some problems keeping liquids from coming up through your nose when drinking (called velopharyngeal insufficiency). Most often, this is only a temporary side effect.
- Mucus in the throat.
- Speech changes.
- Dehydration.
- Bleeding.
Before the Procedure
Be sure to tell your surgeon or nurse:
- If you are or could be pregnant
- If you are taking any medicines, including drugs, supplements, or herbs you bought without a prescription
- If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day
During the week before the surgery:
- You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
- Ask your surgeon which medicines you should still take on the day of your surgery.
- If you smoke, try to stop. Smoking can slow healing. Ask your provider for help quitting smoking.
- Let your provider know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery. If you do get sick, your surgery may need to be postponed.
On the day of the surgery:
- Follow instructions about when to stop eating and drinking.
- Take the medicines your surgeon told you to take with a small sip of water.
- Follow instructions on when to arrive at the hospital. Be sure to arrive on time.
After the Procedure
This surgery most often requires an overnight stay in the hospital to make sure you can swallow. UPPP surgery can be painful and full recovery takes 2 or 3 weeks.
- Your throat will be very sore for up to several weeks. You will get liquid pain medicines to ease the soreness.
- You may have stitches in the back of your throat. These will dissolve or your doctor will remove them at the first follow-up visit.
- Eat only soft foods and liquids for the first 2 weeks after surgery. Avoid crunchy foods or foods that are hard to chew.
- You will need to rinse your mouth after meals with a salt-water solution for the first 7 to 10 days.
- Avoid heavy lifting or straining for the first 2 weeks. You may walk and do light activity after 24 hours.
- You will have a follow-up visit with your doctor 2 or 3 weeks after the surgery.
Outlook (Prognosis)
Sleep apnea improves at first for about half of the people who have this surgery. Over time, the benefit wears off for many people.
Some studies suggest that surgery is best suited only for people with abnormalities in the soft palate.
References
Katsantonis GP. Classic uvulopalatopharyngoplasty. In: Friedman M, Jacobowitz O, eds. Sleep Apnea and Snoring. 2nd ed. Philadelphia, PA: Elsevier; 2020:chap 32.
Qaseem A, Holty JE, Owens DK, et al; Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159(7):471-483. PMID: 24061345
Sarber KM, Lam DJ, Ishman SL. Sleep apnea and sleep disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 15.
Version Info
Last reviewed on: 6/4/2023
Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
