Uvulopalatopharyngoplasty Versus Laser-Assisted Uvulopalatoplasty for the Treatment of Obstructive Sleep Apnea

Uvulopalatopharyngoplasty (UPPP) was the first surgical procedure specifically designed to address the palatal abnormalities seen in many patients with obstructive sleep apnea syndrome (OSAS). For adult apneic patients, UPPP remains the most commonly performed operation. Beginning in 1993, laser-assisted uvulopalatoplasty (LAUP) was introduced for the treatment of snoring and sleep apnea. LAUP differs from UPPP because it is performed in the office using only local anesthesia, thus being very cost-effective. Seventy-nine patients with OSAS underwent surgical treatment: 38 treated with LAUP and 41 with UPPP. The overall surgical response rate, defined as a>50% reduction in the postoperative respiratory disturbance index (RDI), was achieved in 21 (51.2%) of UPPP-treated and 18 (47.4%) of LAUP-treated patients. The RDI decreased from 30.3 ± 3.7 to 22.2 ± 4.4 events/h in the LAUP patients and from 52.1 ± 5.0 to 25.5 ± 2.7 events/h in the UPPP patients. The lowest oxyhemoglobin saturation (LS_aO₂) increased from 72.8 ± 2.1 to 80.9 ± 1.3% in the UPPP patients; there was no change in the LAUP patients. Postoperative complications in this series included minor bleeding, oral candidiasis, and temporary velopalatal insufficiency in both groups. In the carefully selected OSAS patient, LAUP should be considered a surgical alternative to UPPP. LAUP may actually be preferable to UPPP in certain cases because LAUP is cost-effective, does not require a general anesthetic or hospitalization, has very few associated complications, and time lost at work is minimal.     

Uvulopalatopharyngoplasty Versus Laser Uvulopalatoplasty: Prospective Long-term Follow-up of Self-reported Symptoms

Abstract

Conclusion. In addition to functional ameliorations we have shown that septoplasty creates a long-lasting improvement in quality of life in patients with nasal septal deviation. Objectives. The goal of this study was to evaluate whether nasal septal surgery alters patients' quality of life. Patients and methods. This 7-year retrospective study was undertaken in an otolaryngology center. A total of 600 patients who underwent septoplasty with or without turbinectomy in the past 7 years for the indication of septal deviation, were mailed a questionnaire to assess their quality of life after surgical intervention. The questionnaire with 24 items was summarized into 7 subscales (overall medical state, nasal symptoms, accompanying symptoms, sleep, practical problems, emotions and social life). A visual analog scale was provided to measure the patients' general feelings related to their nasal disease. Results. In all, 285 patients (47.5%) responded. Analysis of the questionnaire showed an improvement in all disease-specific subgroups.     

Objective Assessment of Snoring Before and After Laser-Assisted Uvulopalatoplasty

Laser-assisted uvulopalatoplasty (LAUP) is an outpatient staged surgical procedure for the treatment of snoring. Each patient undergoes a series of procedures with the end point being patient and bed partner satisfaction in most cases. The purpose of this study was to objectively evaluate the frequency, pattern, and volume of snoring in patients prior to and following each LAUP procedure. A sonographic device, SNAP^®, which records oronasal respiration, was used to assess patients at home. A digital analysis of the frequency, pattern, and volume was then performed. Twenty-seven patients have been completely evaluated with this recording device. The findings demonstrate that the LAUP procedure alters the snoring sound. The maximum, average, and velumlike respiratory noise loudness all showed a statistically significant decrease when comparing the preoperative snoring to the final recording after treatment was completed. In addition, the fundamental frequency of the snoring increased significantly after each LAUP procedure. No change was seen in the snoring index following treatment. These objective results correlated well with the subjective responses of the patients and their bed partners. These findings are consistent with the hypothesis that the LAUP procedure alters snoring in a favorable manner by both objective data and subjective accounts.     

Stapedectomy Training With the Carbon Dioxide Laser

All primary carbon dioxide (CO₂) laser stapedectomies supervised by the senior author since 1986 were retrospectively reviewed and reported according to 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing guidelines. Sixty-three cases had more than 6 weeks of follow-up with an average residual gap of 6.49 dB (SD = 5.55 dB) and an 89% success rate. Thirty cases had more than 1 year of follow-up with the average hearing result of 6.58 dB (SD = 5.93 dB) and an 87% success rate. In 11 cases, 14 operative problems or complications occurred. Suctioning the vestibule occurred in five cases. Because suction is required to evacuate laser smoke, these cases are attributed to the laser. One of these patients had delayed sensorineural hearing loss. One patient had profound delayed sensorineural hearing loss as a result of granuloma formation. These were the only major complications. The laser is a tool that gives reproducible technique and good success rates.     

支撑喉镜下CO2激光及几丁糖局部涂布治疗喉狭窄

目的：探讨CO2激光辅以局部几丁糖涂布治疗各种类型喉狭窄的手术方法和疗效。方法：1999年1月-2002年1月在全麻支撑喉镜下共行CO2激光辅以局部几丁糖涂布治疗种类喉狭窄患者21例，其中先天性喉2例，不同原因前联合粘连狭窄13例，后联合璞形成3例，喉乳头状瘤多次手术后喉闭锁2例，甲状腺术后双侧声带外展麻痹行杓状软骨切除术后声门狭窄1例。结果：全部患者术后随访6-24个月，18例拔管保留发声功能；3例再狭窄，2例经再次手术后拔管，无误吸，发声较低沉嘶哑；另一例行喉裂开“T”形管扩张。结论：CO2激光手术 几丁糖局部涂布是一种治疗喉狭窄的有效方法，手术安全简便，可避免颈外进路手术，同时保留较好的发声功能。     

Laser-Assisted Uvulopalatoplasty With Nd:YAG Laser for Sleep Disorders

We evaluated the apnea index (AI), the oxygen saturation above 95% (SA95), the lowest oxygen saturation (LSAT), and snoring before and after laser-assisted uvulopalatoplasty (LAUP) in 106 patients with obstructive sleep apnea syndrome (n=59) or snoring (n=47). Type 1 LAUP was performed in 42 patients and type 2 LAUP in 64 patients. A 50% or greater reduction in AI was observed in 15 patients (35.7%) who underwent type 1 LAUP and 37 patients(57.8%) who underwent type 2 LAUP. Snoring was diminished in 18 (51.4%) of 35 patients who underwent type 1 LAUP and 30 (55.6%) of 54 patients who underwent type 2 LAUP. SA95 and LSAT showed no difference. No serious complications such as significant bleeding, postoperative episodes of asphyxia, nasopharyngeal stenosis, or nasal regurgitation were observed. LAUP was an effective outpatient treatment.     

激光辅助悬雍垂腭成形术后语音的客观评价

为客观评价激光辅助悬雍垂腭成形术(LAUP)对语音有无影响,利用USSA计算机语图频谱分析系统,对15名LAUP手术患者,进行了手术前.后2～3周/a/、/i/、/e/、/u/、/(?)/汉语单元音五个共振峰模式、基频和舌根软腭辅音/g/、/k/、/h/三维语图强频区频率的比较.结果显示;各元音前三个共振峰频率及基频在手术前后的变化无统计学意义,术后三个辅音的强频区频率改变也不明显,说明LAUP手术对汉语单元音的音质无影响,也不影响辅音的发音,     

Endoscopic Treatment of Tracheal Stenosis Using the Carbon Dioxide Laser and the Gianturco Stent: Indications and Results

The self-expandable Gianturco stent was used in 11 patients with tracheal stenosis who were treated from September 1992 through July 1994. Under optical control, the stent was placed through a bronchoscope with an outside diameter of 9 mm after cross-section and dilation of the stenosis were performed with the carbon dioxide laser according to the Shapshay technique. The follow-up period varied from 3 to 22 months, with a mean of 12±6 months. Pulmonary function tests showed a mean improvement of the peak expiratory flow (50%), from 0.95±0.45 L/sec before the operation to 2.13±0.86 L/sec after the procedure. Radiologic and fibroscopic controls showed prosthesis stability. Three patients needed a second endoscopic procedure because of malposition of the stent, the formation of granuloma at the superior end of the prosthesis, and the development of a mucous membrane webbing between the two loops of a stent. Due to the lack of long-term follow-up, this technique is reserved for the treatment of severe tracheal stenosis with cartilage impairment in patients who have contraindications for external reconstructive surgery.     

Laser Assisted Uvulopalatoplasty: an objective evaluation of the technique and results

The operation of Laser Assisted Uvulopalatoplasty (LAUP) as described by Kamami is now becoming more commonly used in the treatment of snoring and obstructive sleep apnoea. The authors have treated 95 snoring patients, varying the lengths of the soft palate incisions and percentage of uvula excised. All operations were carried out under general anaesthesia using a CO₂ laser. Pilot studies showed incisions that are 25% of the distance between the free edge of the soft palate to the hard palate junction and excision of 50% of the uvula give good results with minimal complications. A further study using these parameters was conducted and postoperative evaluation including polysomnography confirmed this procedure to be effective in reducing snoring levels both subjectively and objectively.     

早期声门型喉癌患者CO2激光治疗后嗓音功能评估

目的通过主观及客观评估分析早期声门型喉癌患者喉内镜下CO2激光治疗后嗓音功能恢复情况。方法回顾性分析1999年10月至2005年10月接受CO2激光手术治疗的112例声门型喉癌(Tis15例、T1a53例、T1b15例、T229例)患者的术后疗效及嗓音恢复情况,于术后6个月对103例局部无复发及4例复发后行二次激光手术后6个月的患者进行嗓音障碍指数(voice handicap index,VHI)评估表自我评分及嗓音客观评估,包括:嗓音声学分析、电声门图、最长发声时间测试;其中85名患者完成VHI问卷调查。选择50例健康男性作为正常对照组。全部病例于术后6个月进行频闪喉镜检查。声带切除方式按2000年欧洲喉科学会制定分类方案划分为5型,对比组间差异,并与正常对照组比较。结果依照Kaplan-Meier方法计算5年整体生存率为90.24%。声带上皮下切除组、声韧带下切除组与对照组嗓音参数比较,差异无统计学意义(P>0.05),VHI得分均显示正常或轻度嗓音障碍。而经肌肉声带切除组、声带完全切除组及扩大声带切除组与对照组嗓音参数比较,差异有统计学意义(P<0.05),51.8%的患者VHI分值处于中至重度嗓音障碍。结论CO2激光外科治疗早期声门型喉癌疗效确切,可较好保全喉发声功能。其中声带上皮下切除(Ⅰ型)及声韧带下切除(Ⅱ型)术后可恢复近乎正常的嗓音。     

Transoral Robotic Surgery Using a Carbon Dioxide Flexible Laser for Tumors of the Upper Aerodigestive Tract

Objective: To determine the safety, feasibility, and efficacy of coupling transoral robotic technology with the flexible carbon dioxide (CO₂) laser for various tumors of the oropharynx and supraglottic larynx. Study Design: Prospective, pilot trial. Methods: Eight patients were enrolled in an IRB‐approved prospective trial for transoral robotic surgery with the aid of the flexible CO₂ laser. Results: Seven male patients with early carcinoma of the oropharynx or larynx successfully underwent tumor extirpation with the transoral robot and the flexible CO₂ laser. We were unable to gain access to the supraglottic larynx in one female patient. The final pathology revealed seven patients with squamous cell carcinoma and one patient with adenoid cystic carcinoma. The flexible CO₂ laser provided fine incisions with excellent hemostasis and minimal peripheral tissue injury. Additionally, the laser provided an excellent tool for raising pharyngeal flaps for reconstruction of the oropharynx. Conclusion: The flexible CO₂ laser offers a unique advantage of precise incisions and may provide a valuable tool for both tumor extirpation and the creation of flaps for transoral robotic reconstruction.     

声带癌T1的激光与放射治疗对喉发声机能的影响

目的 探讨声带癌Ｔ１的ＣＯ２激光治疗与放射治疗对喉发声机能有何不同影响。方法 ２４例声带癌Ｔ１患者,９例行ＣＯ２激光治疗,７例放射治疗,８例ＣＯ２激光与放射联合治疗。于治疗前后行频闪喉镜检查,噪音声学分析（ＡＰＱ,ＰＰＱ,ＮＮＥｂ,ＮＮＥａ）,喉平均呼气流率（ＭＦＲ）检测及噪音听觉评价分析。结果 放射加激光联合治疗对发声功能较单独应用激光或单独应用放射的影响大。ＣＯ２激光治疗组噪音音质改变为粗糙型     

Persistent Dysphagia after Laser Uvulopalatoplasty: A Videoradiographic Study of Pharyngeal Function

In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae after the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.     

Laser-Assisted Uvulopalatoplasty for the Treatment of Mild,Moderate, and Severe Obstructive Sleep Apnea

Objectives/Hypothesis: Until recently, laser-assisted uvulopalatoplasty (LAUP) has been used to treat only snoring and mild cases of obstructive sleep apnea (OSA). The purpose of this study was to evaluate the efficacy and safety of LAUP in patients with mild, moderate, and severe OSA. Study Design: A prospective study of 38 patients who completed LAUP for the treatment of OSA who were evaluated based on the severity level of their preoperative apnea. Materials and Methods: Between July 1993 and December 1995, 96 patients with a diagnosis of OSA based on polysomnography underwent staged outpatient LAUP treatment. Thirty-eight patients completed treatment and obtained postoperative polysomnography. Postoperative complications and polysomnographic findings were reviewed. Results: Fifteen patients had a diagnosis of mild apnea, 12 had moderate apnea, and 11 had severe apnea based on preoperative polysomnography. The surgical response rates, defined as greater than or equal to 50% reduction in the postoperative respiratory disturbance index (RDI) and a postoperative RDI of less than 20, were 46.7% in the mild apneics, 41.7% in the moderate apneics, and 45.5% in the severe apneics. Postoperative complications in this series included minor bleeding, oral candidiasis, and temporary velopharyngeal insufficiency. There were no serious complications. Conclusions: In the carefully selected and prepared patient with mild, moderate, or severe OSA, LAUP should be considered a surgical option for the treatment of this disorder. LAUP remains a cost-effective and safe alternative to uvulopalatopharyngoplasty.     

Laser Versus Cold Instruments for Microlaryngoscopic Surgery

Controversy has arisen concerning the merits of the CO₂ laser in microlaryngoscopic surgery because of the potentially harmful effects that the injudicious application of the laser could have on voice production. In an effort to develop a logical approach to instrument selection, the author examined the use of both cold instruments and the CO₂ laser in the treatment of various benign and malignant lesions. A retrospective review of 307 microlaryngeal procedures performed over a 3-year period revealed that 263 (86%) were glottal and 44 (14%) were supraglottal. Of the 263 glottal procedures, 203 (77%) employed cold instruments alone and 60 (23%) used both cold instruments and the CO₂ laser. The laser was used to assist in all 44 supraglottal procedures. Therefore, 203 (66%) of 307 procedures were done with cold instruments alone, and 104 (34%) of 307 procedures were performed using the CO₂ laser with cold instruments. Lesions were stratified on the basis of pathology and size, as well as surgical approach. A primary phonomicrosurgical principle in glottal surgery is to maximally preserve the vocal fold's layered microstructure (laminae propria and epithelium). Precise tangential dissection was necessary for achieving this goal. For limited lesions, this dissection was best accomplished with cold instruments alone. The CO₂ laser facilitated hemostatic surgical dissection for all supraglottal lesions and for selected larger glottal lesions in which bleeding would obscure visualization of the microanatomy of the musculomembranous vocal fold. Laryngoscope, 106:545-552, 1996     

CO2激光照射豚鼠耳蜗对内耳结构和功能的影响

目的探讨不同功率CO2激光照射豚鼠耳蜗后其内耳结构和功能的影响.方法 24只红目豚鼠分3组,每组8只,分别以功率为1、2、3 W,功率密度分别为796、1 592、2 388 W/cm2的CO2激光照射左耳耳蜗底周,以右耳为对照,术前及处死前分别行听性脑干反应(ABR)检查,分术后即刻和术后3周两批断头处死,应用光镜和扫描电镜技术观察耳蜗形态学变化.结果激光照射术后即刻3组豚鼠听阈较术前明显升高(1 W组P<0.05;2 W组P<0.05;3 W组P<0.01),照射后3周1 W组听阈基本恢复(P>0.05),2 W、3 W组听阈有所下降但仍高于术前(P<0.05).照射后即刻,光镜下见3组豚鼠耳蜗外毛细胞出现肿胀,硝酸银浓染,血管纹血管扩张;照射后3周,扫描电镜观察1 W组内耳结构轻微改变, 2 W组出现散在的外毛细胞静纤毛的倒伏,排列紊乱,3 W组出现外毛细胞静纤毛严重缺失、破坏和融合呈球状.结论应用CO2激光行耳科手术时,应注意功率及功率密度的选择,以免造成内耳损伤.     

Thermal Injury Patterns and Tensile Strength of Canine Oral Mucosa After Carbon Dioxide Laser Incisions

The amount of collateral damage in laser surgery is affected by the precision of the beam delivery. To test a new control system, the authors of this study produced surgical incisions in the canine oral mucosa and then documented histologic and tensile strength changes during the wound healing process. The incisions were made by three different methods: scalpel, manually controlled carbon dioxide (CO₂) laser, and computer-controlled CO₂ laser. Both types of laser incisions took longer to heal than the scalpel incisions. The laser incisons were accompanied by a zone of thermal damage lateral to the incision. With the computer-controlled laser incision, the area of thermal damage was reduced, the laserinduced delay in wound healing was less, and tensile strength was relatively greater. The data indicate that surgical performance is improved by critical beam control. Laryngoscope, 106:845-850, 1996     

Identifying Obstructive Sleep Apnea in Patients Presenting for Laser-Assisted Uvulopalatoplasty

The authors report on a series of 850 patients with snoring who were evaluated for laser-assisted uvulopalatoplasty (LAUP). Stepwise multivariate linear regression was employed to correlate patient symptoms and characteristics to the respiratory disturbance index (RDI). Body mass index, falling asleep while driving, snoring every night, and stopping breathing during sleep were found to correlate strongly with an increasing RDI (variance of 25%). Logistic multivariate linear regression analysis was used to predict the outcome of apnea (RDI>10). This model selected all of the above variables, as well as age, male sex, and the total number of symptoms, as being strong predictors of apnea. A receiver operating characteristic curve was used to describe the ability of this model to predict apnea. The authors conclude that otolaryngologists play an important role in the evaluation of OSAS, especially when a snoring patient may undergo LAUP, and they present an algorithm for the evaluation of such a patient. The authors believe that the clinical assesment, including a thorough history and a complete physical examination, remains extremely important in this evaluation. At present, the authors strongly recommend referral for a PSG if there is any suspicion of OSAS.     

Histologic Study of Oral Mucosa Wound Healing: A Comparison of a 6.0- to 6.8-µm Pulsed Laser and a Carbon Dioxide Laser

Incisional wound healing in the canine oral mucosa was histologically monitored at 3, 7, and 14 days after incision. Healing was compared from a scalpel, a carbon dioxide (CO₂) laser at 10.6µm, and the Vanderbilt free-electron laser tuned to 6.0, 6.45, and 6.8µm. A significant delay in wound healing was observed when incisions were made with the CO₂ laser, probably attributable to the excess thermal damage caused by the continuous-wave laser beam. When using the short pulsed, free-electron laser, a much smaller delay comparable to the scalpel wound healing was observed. This smaller delay tended to decrease with increasing tissue absorption. The results emphasize the greater importance of laser pulse duration rather than wavelength in relation to the subsequent wound healing.