Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty
Intervention
View of the throat 8 years following uvulopalatopharyngoplasty.
ICD-9-CM	27.6, 27.7, 29
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Uvulopalatopharyngoplasty (also known by the abbreviations UPPP and UP3) is a surgical procedure or sleep surgery used to remove tissue and/or remodel tissue in the throat. Tissues which may typically be removed include:

Tissues which may typically be remodeled include:

UPPP involves the tonsils, followed by removal of the anterior surface of the soft palate and uvula, folding of the uvula toward the soft palate and suturing it together as demonstrated in the figures. In the US, UPPP is the most commonly performed procedure for obstructive sleep apnea, with approximately 33,000 procedures per year. The surgery is more successful in patients who are not obese, and there is a limited role in morbidly obese (>40 kg/m2).

Standard UPPP procedure

UPPP is typically administered to patients with obstructive sleep apnea in isolation. It is administered as a stand-alone procedure in the hope that the tissue which obstructs the patient's airway is localized in the back of the throat. The rationale is that, by removing the tissue, the patient's airway will be wider and breathing will become easier.

The Role of UPPP in the "" operation

UPPP is also offered to sleep apnea patients who opt for a more comprehensive surgical procedure known as the "The Stanford Protocol", first attempted by Doctors Nelson Powell and Robert Riley of Stanford University. The Stanford Protocol consists of two phases. The first involves surgery of the soft tissue (tonsillectomy, uvulopalatopharyngoplasty) and the second involves skeletal surgeries (maxillomandibular advancement). First, Phase 1 or soft tissue surgery is performed and after re-testing with a new sleep study, if there is residual sleep apnea, then Phase 2 surgery would consist of jaw surgery. The goal is to improve the airway and thereby treat (or possibly cure) sleep apnea. It has been found that obstructive sleep apnea usually involves multiple sites where tissue obstructs the airway; the base of the tongue is often involved. The Protocol successively addresses these multiple sites of obstruction. Note that genioglossus advancement can be performed either during Phase 1 or Phase 2 surgeries.

Phase 2 involves maxillomandibular advancement, a surgery which moves the jaw top (maxilla) and bottom (mandible) forward. The tongue muscle is anchored to the chin, and translation of the mandible forward pulls the tongue forward as well. If the procedure achieves the desired results, when the patient sleeps and the tongue relaxes, it will no longer be able to block the airway. Success is much better for Phase 2 than for Phase 1 - approximately 90 percent benefit from the second phase, and the success of the Stanford Protocol Operation therefore is due in large part to this second phase.