UPPP Surgery Procedure

The following information is from the ASAA about this procedure, excerpt provided below:
Link to ASAA information
The most common surgery for sleep apnea is the uvulopalatopharyngoplasty, or UPPP procedure, which is intended to enlarge the airway by removing or shortening the uvula and removing the tonsils and adenoids, if present, as well as part of the soft palate or roof of the mouth. (The uvula is the tissue that hangs from the middle of the back of the roof of the mouth; the word comes from the Latin "uva" meaning "grapes.") According to the "Practice Parameters for the Treatment of Obstructive Sleep Apnea: Surgical Modifications of the Upper Airway," issued in 1996 by the American Academy of Sleep Medicine (formerly the American Sleep Disorders Association), the overall efficacy is 40.7%. A more recent surgery using a laser (laser-assisted uvulopalatoplasty or LAUP, a modification of the UPPP where the surgeon cuts the uvula with a laser) is performed for snoring. There is not yet enough information to say whether LAUP is effective for OSA.

The following link provides a description of the UPPP surgery procedure. Below is the description from the link.
University of Maryland Medical Center information about surgery options

Uvulopalatopharyngoplasty (UPPP)

The Procedure. Surgery known as uvulopalatopharyngoplasty (UPPP) removes soft tissue on the back of the throat Such tissue include all or part of the uvula (the soft flap of tissue that hangs down at the back of the mouth) and parts of the soft palate and the throat tissue behind it. If tonsils and adenoids are present, they are removed. The surgery typically requires a stay in the hospital.

The Goal of Surgery. The object of UPPP is threefold:
  • To increase the width of the airway at the throat's opening.
  • To block some of the muscle action in order to improve the ability of the airway to remain open.
  • To "square off" the soft palate to improve its movement and closure.
Success Rates. Success rates for sleep apnea surgery are rarely higher than 65% and often deteriorate with time, averaging about 50% or less over the long term. Few studies have been conducted on the which patients make the best candidates. Some studies suggest that surgery is best suited for patients with abnormalities in the soft palate, which may or may not involve the tonsils. Results are poor if the problems involve other areas or the full palate. In such cases CPAP is superior. In one study, sleeping on the side (rather than the back) after surgery boosted success rates significantly.

Complications. Uvulopalatopharyngoplasty is among the most painful treatments for sleep apnea, and recovery takes several weeks. It is recommended only for select patients with severe obstructive sleep apnea. The procedure also has a number of potentially serious complications. In fact, in one study, 42% of patients had complaints about the procedure. Some complications include the following:
  • Infection. (In one study this complication was so common that 40% of patients needed another operation because of it.) Preventive antibiotics administered an hour before surgery can help reduce this risk.
  • Impaired function in the soft palate and muscles of the throat.
  • Mucus in the throat.
  • Changes in voice frequency.
  • Swallowing problems.
  • Regurgitation of fluids through the nose or mouth.
  • Impaired sense of smell.
  • Failure and recurrence of apnea. In such cases, continuous positive airway pressure (CPAP) is often less effective afterward, although one study found that oral appliances may still help.
In one review of studies, 20% of patients who had UPPP required tracheostomy afterward [ see below ]. Most of these complications can be avoided with proper technique and experienced surgeons. The use of lasers with UPPP is being investigated.

Laser-Assisted Uvulopalatoplasty (LAUP)

A variation on UPPP called laser-assisted uvulopalatoplasty (LAUP) is being increasingly performed to reduce snoring. It removes less tissue at the back of the throat than UPPP and can be done in a physician's office. At this time, however, long-term success rates from LAUP are less than 50%. Common complications include throat dryness (over 50%). Throat narrowing and scarring have been reported. In a minority of patients, snoring becomes worse afterward. There is also not enough evidence to determine if LAUP improves apnea at all. In fact, in one study, more than 30% of patients had worse breathing disturbance after LAUP. Some physicians are also concerned that if LAUP eliminates snoring, then a diagnosis of apnea may be missed in patients who have the more serious condition.

The following is a link to different discussion board posts of personal experiences with surgeries, including the UPPP:
Link to descriptions of personal experiences with surgeries