Snoring: physiopathology, surgical treatment and a modified uvulo-palato-pharyngoplasty

Sleep apnea, now recognized as a specific clinicopathological entity, had received little attention until late 1960 when described by Gastaud. Since that time, following the works of Ikematsu, Guillemineault and Fujita, there has been rapid extension in the knowledge and understanding of sleep problems and associated surgery. Snoring, whether part of the sleep apnea syndrome or alone, may be explained with the help of an aerodynamic model comparing the pharynx to a Starling resistance. The factors nasal obstruction, abnormal mass in the upper respiratory airways and transmural resistance are discussed in the light of this model. To modify some of the above factors, surgical techniques have been described. We feel these conventional techniques do not take into account the normal healing process of inverted double C scars. We have modified the classic technique by sectioning the palatopharyngeus muscle and used Z-plasty to close the surgical defect. This is followed by a limited resection of the soft palate. As a consequence, the soft palate is being brought forward in the healing process and the oropharynx AP diameter is enlarged. This minimal type of resection of the soft palate precludes complications of velopharyngeal incompetency or relative pharyngeal stenosis. We have studied 200 snorers and operated on 90 of them, 25 according to the standard technique and 65 with the modified technique. The modified technique, while limiting the amount of palate to be removed and also the morbidity, is easy to standardize and offers as good results with fewer risks.