Treatment of primary snoring using radiofrequency-assisted uvulopalatoplasty

Laser-assisted uvulopalatoplasty (LAUP) reduces the need for general anesthesia, bleeding and the operation time compared with uvulopalatopharyngoplasty (UPPP), but the postoperative pain is more severe due to the thermal damage to tissues, and the procedure often causes serious scar contracture of the soft palate, with foreign body sensation also occurring occasionally. Radiofrequency-assisted uvulopalatoplasty (RAUP) uses the same surgical method as LAUP, but employs RF instead of laser. RF surgery induces temperatures of 70–85°C, and causes less damage to the surrounding tissues. Thus, on the assumption that it may reduce problems in LAUP, we applied LAUP and RAUP at random to patients with primary snoring, and compared the results of the two types of operation and both their advantages and disadvantages. Forty-four patients with primary snoring but without apnea were prospectively evaluated with a follow-up period of 6 months: 20 patients received LAUP and 24 patients received RAUP. Postoperative changes in the subjective degree of snoring, the Epworth sleepiness scale score, and the operation time, postoperative pain, episodes of delayed bleeding, globus sensation and scar contracture were compared between the two surgical methods. Snoring symptoms, ESS scores and episodes of delayed bleeding did not differ significantly between the two groups. The operation time was shorter in the LAUP group, and the postoperative pain and postoperative complications (globus sensation and scar contracture) were less in the RAUP group. RAUP results in significantly lower postoperative pain, complications and other problems experienced in LAUP, while maintaining the advantages of LAUP.     

Treatment of obstructive sleep apnea syndrome using radiofrequency-assisted uvulopalatoplasty with tonsillectomy

Radiofrequency surgery was introduced to minimize thermal damage to the tissue. A radiofrequency electrode can be used to make cuts in the free edge of the soft palate like those done in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. Tonsillectomy can enlarge the lateral diameter of the pharynx. The aim of our study was to evaluate the efficacy of RAUP with tonsillectomy in treatment of obstructive sleep apnea syndrome (OSAS). Ninety-two patients with obstructive sleep apnea were included in this study. Patients were categorized according to disease severity and Friedman’s staging system. Patients were assessed with the preoperative visual analog scale (VAS) for snoring, Epworth Sleepiness Scale (ESS) and apnea–hypopnea index (AHI) at baseline and repeated at 6 months postoperatively. The intensity of postoperative pain, speech deficits and dysphagia were also recorded. There was a significant improvement in the VAS score for snoring, ESS and AHI before and after surgery. Overall, the results of the present study indicated a surgery success rate (a 50 % decrease in AHI and AHI <20) of 66 % (61 of 92 patients). Postoperative pain, speech deficits and dysphagia were reduced at 2 weeks after surgery. The results of this study suggest that RAUP with tonsillectomy is an effective treatment for patients with OSAS.     

Comparison of uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty and cautery-assisted uvulopalatoplasty in the treatment of primary snoring

OBJECTIVE: Our aim was to compare the postoperative pain and surgical results of uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP), and cautery-assisted uvulopalatoplasty (CAUP) procedures in the treatment of primary snoring. METHODS: 54 patients were stratified according to a modified Friedman staging system (MFSS) for sleep-disordered breathing. Tonsil size (1, 2, 3) and palatal position scale (grade 1-2) and body mass index <30 according to the MFSS were included for standardization. Three workgroups consisting of 18 patients each were formed and UPPP, LAUP and CAUP procedures were performed. The success of the surgical procedures was evaluated by applying the Epworth Sleepiness Scale to the patients, and the patients' bed partners were asked to evaluate the snoring level preoperative and 45 days after the operation to determine any improvement in snoring complaints. Patients were followed for postoperative pain, secondary infection, bleeding, permanent velopharyngeal insufficiency and nasopharyngeal stenosis. RESULTS: Snoring was relieved in 83.3% of UPPP and CAUP groups and in 88.8% of LAUP 45 days after operation. The mean pain duration was 5.71 days for the UPPP patients, 6.28 days for the LAUP patients and, 4.12 days for the CAUP patients. The mean pain score was 2.1 for the UPPP patients, 2.38 for the LAUP patients, and 1.6 for the CAUP patients. Only 1 patient was hospitalized due to pain in the LAUP group. CONCLUSION: The effectiveness of UPPP, LAUP and CAUP procedures were found to be similar (more than 83%). Postoperative pain was mostly seen in LAUP and UPPP cases. The CAUP procedure was easy and the least painful.     

Laser uvulopalatoplasty in treatment of habitual snoring

Velopharyngeal sonorous snoring is best treated with uvulopalatopharyngoplasty (UPPP). To reduce surgical risks and minimize the morbidity, a simplified carbon dioxide laser uvulopalatoplasty (LUPP) was performed under local anesthesia. Among a total of 146 patients who had a LUPP performed, there was no significant bleeding or postoperative episodes of asphyxia. The procedure was well tolerated even by those patients with strong vomiting reflexes. The operation time was halved, as was the convalescence. Two patients (1.4%) developed scarring with nasal obstruction, but the impact of factors other than the laser approach itself seemed to be the cause. By scored questionnaires the effect on snoring, family complaints, and daytime somnolence was evaluated in two comparable random groups of patients. Sixty-three patients had LUPP procedures, and 37 had UPPP. The short-term results showed that about 90% of the patients considered themselves essentially improved as regarded snoring and that most patients felt more alert, irrespective of the surgical method used.     

Long-term results of laser-assisted uvulopalatoplasty for snoring.

We present the ongoing results of the series of 53 consecutive patients who underwent laser-assisted uvulopalatoplasty (LAUP) for snoring at the Kent and Canterbury Hospital. Twenty-nine patients (55 per cent) were completely satisfied with their surgery 18 to 24 months following LAUP when previously questioned via telephone questionnaire. We have followed up the 29 patients with a previously successful result at between 70 and 79 months following surgery. They underwent an average of 1.6 procedures. Twelve patients (22 per cent) continue to be completely satisfied at this late stage, and a further 12 (22 per cent) have some ongoing improvement in their snoring. Only three patients have indicated that a previously successful result has failed since the previous survey. The failure rate of LAUP in the treatment of snoring is seen predominantly in the first two years following surgery, but some long-term subjective recurrence of snoring does occur.     

Combined radiofrequency assisted uvulopalatoplasty in the treatment of snoring

Despite its minimally invasive character and superiority over placebo, the clinical efficacy of interstitial radiofrequency surgery (RF) of the soft palate in primary snoring is limited. In particular, excessive soft tissue at the palatal arches (webbing) and uvula hyperplasia are common phenomena, but cannot be addressed with interstitial RF surgery. Aim of this study was to assess the efficacy and morbidity of combined RF assisted uvulopalatoplasty (RF-UPP) in the treatment of snoring. Twenty-two patients with primary snoring (AHI < 15, BMI < 32) were included in the prospective clinical trial. All patients received two sessions of combined RF procedures at the soft palate, consisting of interstitial bipolar RF-surgery (Celon) and RF-assisted resection of excessive soft tissue (Celon ProCut). Snoring and postoperative pain were assessed with a 10-cm visual analogues scale (VAS), before and at least 6 weeks after every treatment session. Twenty-two patients were included and 21 patients completed the study. Snoring scores were reduced after the first session (8.5 ± 1.5–4.6 ± 2.5; P < 0.001) and showed further improvement after the second session (4.6 ± 2.5–2.0 ± 2.1; P < 0.001). Postoperative pain levels of 6.6 ± 2.9 at day 1 decreased to 3.2 ± 3.0 at day 7 after the first session and from 3.8 ± 3.2 at day 1 to 0.4 ± 0.8 at day 7 after the second session. Painkillers were administered for a mean of 2.0 ± 2.5 days. Complications did not occur. Combined radiofrequency assisted uvulopalatoplasty (RF-UPP) is highly effective in the treatment of snoring.     

Long-term outcomes of laser-assisted uvulopalatoplasty in 168 patients with snoring

Laser-assisted uvulopalatoplasty (LAUP) is an established treatment for snoring. Our institution has been using a modification of the Kamami technique since 1995. Between January 1995 and December 2001, 469 patients underwent LAUP for snoring. A telephone survey of these patients and their partners was conducted retrospectively. One hundred and sixty-eight patients and their partners were interviewed and the findings analysed.Of the 168 patients, 122 had LAUP alone, 42 had LAUP and tonsillectomy and four had LAUP and septoplasty. The median follow-up time was 59 months (range 19 to 98 months).Seventy-four per cent reported improvement at six weeks, 69 per cent reported improvement at nine months and 55 per cent reported improvement at the time of interview. To assess the degree of improvement, patients and their partners were asked to grade any improvement in percentage terms. The mean subjective improvement scores were 57 per cent at six weeks (95 per cent confidence interval (CI) 50-64 per cent), 45 per cent at nine months (95 per cent CI 38-59 per cent) and 30 per cent at the time of interview (95 per cent CI 23-35 per cent). Patients who reported weight gain since surgery did not have a poorer outcome than those who reported no weight change or weight loss. Neither did weight loss predict a better outcome. The procedure was generally well tolerated, with only 30 patients (18 per cent) reporting complications (mainly minor). The benefits of LAUP wane with time and the results are best in the first 12 months following surgery. Our study suggests that 55 per cent of patients selected after sleep studies and sleep nasendoscopy will enjoy long-term benefit.     

Laser-assisted uvulopalatoplasty for snoring: medium- to long-term subjective and objective analysis

OBJECTIVE: To assess the subjective and objective medium- to long-term results of laser-assisted uvulopalatoplasty for snoring. DESIGN: A nonrandomized, prospective, before-after trial. SUBJECTS AND INTERVENTIONS: Fourteen patients underwent laser-assisted uvulopalatoplasty surgery; 2 surgical techniques, which differ with respect to the mode of midline palatal vaporization, were used. MAIN OUTCOME MEASURES: Subjective analysis included a preoperative and 2 postoperative evaluations of the state of snoring: 4 weeks and 10.1 +/- 7.9 months (mean +/- SD) after completion of last laser treatment. In addition, a score on 5 other sleep-related symptoms was recorded before treatment and after 10.1 +/- 7.9 months; at that time, patients also estimated their overall satisfaction with the procedure. Objective analysis included preoperative nocturnal polysomnographic studies that were repeated postoperatively. RESULTS: A decline in snoring improvement from 79% (11/14) to 57% (8/14) was recorded; furthermore, state of snoring worsened from 7% (1/14) to 21% (3/14). Likewise, reevaluation of the 5 other sleep-related symptoms at the final follow-up visit uncovered a 57% improvement rate. Overall satisfaction with the procedure was 43%. The results of the postoperative objective studies corresponded to those of the subjective ones and demonstrated significant worsening of respiratory disturbance index in 3 (21%) of the 14 patients, who became mildly apneic. These findings were encountered with both laser techniques. CONCLUSIONS: The favorable subjective short-term results of laser-assisted uvulopalatoplasty deteriorated with time. In addition, postoperative nocturnal polysomnography showed that the procedure caused mild obstructive sleep apnea in a considerable number of patients who formerly were nonapneic snorers. These findings may be related to velopharyngeal narrowing and progressive palatal fibrosis, caused by the thermal damage inflicted by the laser beam.     

Mirror-focused handpiece for laser-assisted uvulopalatoplasty for the treatment of snoring and sleep apnea

We describe how a novel mirror-based laser handpiece device allows for the pinpoint coincidence of aiming and surgical beams during uvulopalatoplasty and other laser ablation procedures.     

Postoperative pain and side effects after uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and radiofrequency tissue volume reduction in primary snoring

OBJECTIVES: We compared, in a prospective study, the side effects and the postoperative complications of three procedures commonly used for the treatment of primary snoring. METHOD: Forty-nine patients underwent velopharyngeal surgery for primary snoring (17 for uvulopalatopharyngoplasty [UPPP]; 15 for laser-assisted uvulopalatoplasty [LAUP], and 17 for radiofrequency tissue volume reduction [RFTVR]). Preoperative full polysomnographic studies ruled out obstructive sleep apnea syndrome. Each patient's evaluation encompassed postoperative pharyngeal pain (as measured by a 5-point visual analogue scale) and use of narcotic drugs in the early postoperative period as well as a subjective evaluation of late postoperative complaints. A surgeon's examination was performed to report postoperative complications in the oropharynx. RESULTS: Postoperative pharyngeal pain was less important in the RFTVR group than in the UPPP and LAUP groups. Mean scores at days 3, 7, 16 were as follows: 4.2, 4.0, and 2.4, respectively, for UPPP; 4.6, 3.8, and 1.6 for LAUP; and 2.4, 2.0, and 0.7 for RFTVR. Mean duration of pain with a score greater than 2 was calculated as follows: UPPP, 21.3 days; LAUP, 15.1 days; and RFTVR, 6.1 days. Mean duration of narcotic drug use for the patients who needed this medication was 10.1 days for UPPP, 7.2 days for LAUP, and 1.3 for RFTVR. Postoperative side effects (trouble with smell and taste, pharyngeal dryness, globus sensation, voice change, and pharyngonasal reflux) were more present in the UPPP and LAUP groups than in the RFTVR group. Surgeon's assessment for postoperative complications reported more wound infection, dehiscence, and posterior pillar narrowing in the UPPP and LAUP groups than in the RFTVR group. CONCLUSION: RFTVR is a safer and less painful procedure than UPPP and LAUP for the treatment of primary snoring. Postoperative discomfort after LAUP and after UPPP appears to be very similar.     

Laser-assisted uvulopalatoplasty for the treatment of snoring and mild obstructive sleep apnea syndrome

OBJECTIVE: To determine the efficacy of the laser-assisted uvulopalatoplasty (LAUP) procedure on snoring and Apnea-Hypopnea-Index (AHI) improvement in patients with snoring and mild obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective, nonrandomized, nonblinded assessment of outcomes after LAUP in patients suffering from benign habitual snoring and/or mild OSAS. METHODS: Fifty-nine patients with habitual snoring and 25 patients with mild OSAS underwent LAUP (6 of them underwent simultaneous classic tonsillectomy and 20 carbon-dioxide laser tonsillotomy). All patients and their bed partners completed pre- and post-treatment questionnaires ranking snoring, whereas the patients with mild OSAS underwent postoperative polysomnography (PSG). RESULTS: During a 6-month to 5-year follow-up (mean 40 months), 91.5% of the patients with habitual snoring reported significant short-term improvement based on post-treatment questionnaires, whereas 79.7% reported long-term subjective improvement. Nineteen of 25 patients (76%) with mild OSAS reported significant improvement of snoring based on posttreatment questionnaires. According to the postoperative PSG, only 2% showed a worse AHI, whereas 60% showed reduction of the AHI to < or = 5. Eight patients (32%) showed little or no improvement of AHI. CONCLUSIONS: LAUP, in combination with carbon-dioxide laser tonsillotomy in some cases, is a safe, cost-effective, outpatient procedure for the treatment of many cases of habitual snoring and mild OSAS when preceded by careful selection of the candidates.     

Laser-assisted uvulopalatoplasty for snoring and obstructive sleep apnea: Results in 170 patients

Laser-assisted uvulopalatoplasty (LAUP) is a procedure for the treatment of snoring and, possibly, sleep apnea. Between July 1993 and December 1994, the authors prospectively evaluated 541 consecutive patients referred to their teaching hospital for possible LAUP to treat loud, disruptive snoring. Of these patients, 274 (51%) had one or more LAUP treatments. As of January 1995, LAUP treatment courses were completed in 170 patients. In this paper, the authors report preliminary results on the use of LAUP in these patients. Among the 170 patients, 105 (62%) had a diagnosis of snoring and 65 (38%) obstructive sleep apnea syndrome (OSAS) based on preoperative polysomnography. LAUP treatment in the snoring only patients resulted in complete or nearly complete elimination of snoring in 63 patients (60%), partial improvement of snoring in 30 patients (29%), and no improvement in 11 patients (10%). Of the 65 OSAS patients treated with LAUP, postoperative polysomnograms were obtained in 33 patients (51%). Surgical success was achieved in 16 (48%) of the 33 patients. However, 7 patients (21%) had repeat polysomnograms that were worse than their preoperative polysomnograms, and 5 patients (15%) had no significant change. The results of this study suggest that LAUP may be a viable surgical option for patients with snoring and mild sleep apnea.     

Complication after laser assisted uvulopalatoplasty in the treatment of snoring and obstructive sleep apnea syndrome

Laser Assisted Uvulopalatoplasty (LAUP) is the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome. LAUP was first time performed by Kamami in 1986. LAUP can reduce the airway obstruction on the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. Between 1997 and 2001 the authors of the study prospectively evaluated 400 patients referred to ENT Clinic in Zabrze to treat the breathing disturbances during sleep. In this group of patients LAUP procedure was performed in 68 cases. There were 4 cases of complications (4.4%). These complications included: postoperative hemorrhage in one patient, 2 cases mycotic infections and in one patient, 2 cases mycotic infections and in one patient temporary loss of taste. In this group of patients there were no cases of bleedings needed hospitalization, nasal speech, nasopharyngeal stenosis, palatal incompetence, airway compromise or death.     

Laser assisted uvulopalatoplasty (LAUP) in the treatment of snoring and obstructive sleep apnea syndrome

Laser Assisted Uvulopalatoplasty (LAUP) the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome was first performed by Kamami in 1988. LAUP can reduce the airway obstruction in the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. From 1998 to 2000 37 patients underwent LAUP in our ENT Department in Zabrze. This group comprised of 19 OSA patients and 18 habitual snorers. In cases of nasal obstruction by turbinate hypertrophy or septal deviation we performed septoplasty or partial inferior turbinectomy by laser CO2. In some cases with palatin or lingual tonsils hypertrophy we also performed tonsillectomy or lingual tonsil laser ablation. In 5 patients LAUP was performed in several stages. Before and after the surgical treatment each patient were evaluated by PolyMESAM--the device belongs to the third diagnostic level. In all postoperative evaluated OSA patients the RDI decreased significantly. In 4 patients (50% of evaluated after LAUP patients) the RDI dropped to 10 or lower. Snoring was eliminated or significantly reduced in 83% of patients classified as the habitual snorers. No serious complications were observed. LAUP is a good alternative to UPPP in the surgical treatment of habitual snorers and some of the patients with OSA syndrome.