Uvulopalatopharyngoplasty (say that three times fast), also known as UPPP, is a surgical procedure intended to clear the
airway of obstructions. It is most commonly used in cases of severe
obstructive sleep apnea, where the
soft tissue trauma from snoring can actually cause various bits of the throat to expand. The name of the procedure is built from the three parts of the throat it affects:
- uvulo: refers to the uvula.
- palato: indicates the soft palate.
- pharyngo: means the pharynx is involved.
The
-plasty informs us that this is
plastic surgery, as opposed to, say, a procedure intended to repair structural damage or remove a
malignant growth. Otherwise healthy
tissue is being modified for the patient's benefit.
In essence, the surgery will involve three parts. First, the removal of the uvula; second, the modification of the soft palate, and third, modification of the tissue around the pharynx. The intent is that these all contribute to the patient's ability to breathe while supine and asleep. At present, this surgery is done entirely through the mouth, requiring no incisions to access the area. Since it requires the patient to be intubated during the procedure, it is performed under general anaesthesia, which increases its risk slightly since general brings its own risks to the table. As such, it typically requires a one- or two-night stay in the hospital.
Success is varied. In approximately 50% of cases, the surgery produces 'notable' to 'complete' relief of airway obstruction. In some cases, it produces no discernable change, and in some few cases it can actually make things worse, if scar tissue forms which itself blocks the airway. If you suffer from sleep apnea, this procedure should be far down your list of things to try! See a qualified sleep specialist, who will likely recommend everything from posture modification while sleeping to weight loss (obesity is the number one cause of sleep apnea). In more serious cases, CPAP is indicated. In most cases following a UPPP, CPAP is still required to some degree. The procedure is mostly recommended to the minority of patients for whom CPAP is initially ineffective due to airway obstruction. UPPP is, unfortunately, associated with a relatively lengthy recovery period (typically around two weeks for pain to subside).
There are alternatives to UPPP in some cases, such as Radiofrequency Tissue Reduction of the tongue, if in fact the patient has lingual obstruction, or Laser-Assisted Uvuloplasty (LAUP).
In my case, CPAP doesn't presently work because there are some obstructed parts of my airway which actually close up when higher pressure is applied to the front of my airway by the CPAP machine, inducing the very symptom the machine is designed to prevent. Also, I did not have my tonsils out as a child, and for various reasons, my tonsils have expanded, causing blockage.
Sources:
- http://www.stanford.edu/~dement/apnea.html#uppp - Dr. Dement's page at Stanford on Sleep Apnea
- http://www.snoringtreatment.com/uppp.htm
- WebMD
- Personal briefings on upcoming surgery
I'll report on the aftereffects - I'm due to have a combination tonsillectomy and UPPP on May 6th, 2004.
Pre-Op: Quick, painless. Basic check-in to the hospital (will be there for an overnight stay due to use of general anaesthesia). Only nasty part: insertion of IV catheters for drug delivery.
Post-Op: Woke up in recovery; transferred to room. Had morphine adminstered at this point, so recollections hazy (grin). Not so much pain yet, just big 'feeling of wrongness' in throat, general woozy from the drugs.
First Night: Pain shows up, with teeth. Wet, gleaming ones. More morphine is administered (yay!) and that takes care of most of that. CPAP is put on me experimentally, but is deemed to be putting too much pressure on the sutures. I'm mouthbreathing at this point.
One day post: Released from hospital. Primary event was managing to wash out my mouth and throat, which were completely clogged w/phlegm and blood clot from the surgery. No serious bleeding afterwards; breathing is already noticeably easier. Pain remains, of course. Prescribed Roxicet and Viscous Lidocaine for pain, and Ceftin for antibiotic course. the Roxicet is good stuff - OxyCodone and Acetominophen in solution, with that yummy 'we call it cherry!' flavor we all love from cough syrup. Told to take 5 ml every four hours for pain, and they gave me a half-liter. Whee!
Two days post: Settle in to home routine. Roxicet leads to slight spaciness. Pain in throat has localized. Breathing, talking not painful at this point; just swallowing. Subsisting on popsicles, ice cream and instant soup (yay!). Made the cardinal mistake of examining the back of my throat via mirror and flashlight. Whoops. Much white, dead (cauterized during surgery) tissue; black whorls of sutures, lots of phlegm, occasional scab. Ew.
Five days post: Still not eating. Pain is limited to slight twinging other than when swallowing. The affected area is highly sensitive to acid, so orange juice is a BAD IDEA. Start using CPAP at night. Note that other than problems from excessive phlegm production (which is, I'm told, expected) breathing (especially at night) is already much easier. Go elective surgery! I've starting dreaming about steaks, fried chicken, hot sausages, and in fact anything that doesn't have the consistency of mush.
Eight days post: Still not eating, save for Ramen Noodles which are nice and smooshy. Had to be at work, briefly, and was there when our weekly pizza orgy arrived. Bad, bad plan. In a moment of weakness, snarfed half a slice of pepperoni before realizing (the hard way) that not only is pizza crust scratchy as heck, but that tomato sauce is only slightly less acidic than, say, engraving fluid. OUCHOUCHOUCHOUCHmotherfucker.
Ten days post: Finally managed a plate of food - Indian food, murg makhni I believe. The creamy stew and the rice did minimal damage, and there has been no aftereffects. Tomorrow, I may try a hamburger. On the non-food-front, my sutures appear to have released in some way; I also think the dead skin in my throat finally cracked and began to peel. There are billows of (hurting) flesh protruding back into the spaces where there had been blessedly nothing to interfere with my breathing. My doctor tells me that this is normal, and that the throat, now free of the stitches and dead skin, is swollen in protest of the trauma. This should go down over the next week or so as it heals up. I did manage to go the entire day without Roxicet, which I am not sure is a good thing, but has to count for something.
Twelve days post: A HAMBURGER. Ecstasy. Throat is still swollen, but the pain is nearly gone and the swelling has receded slightly. Going in for my post-op checkup tomorrow. Trying not to eat like the pig I want to be, as I'm enjoying the 18 lbs I appear to have lost...this may be a losing battle (ha ha) but it's worth fighting.