What is Uvulopalatoplasty? And different methods to do Uvulopalatoplasty?

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What causes snoring?

Upper respiratory tract is formed of nose or nostrils, nasal cavity, mouth, throat and voice box or larynx. The upper air way passage allows breathing of air in and out of lungs. It is a medium of exchange of gases like oxygen and carbon dioxide. It heats, humidifies and filters air. The complex muscle structure in upper airway tract produces speech and regulates respiratory flow through out respiratory cycle. The upper respiratory tract is vulnerable to several environmental infections. These infections and diseases of upper respiratory tract are common in children and adults that often block normal passage of air. Obstruction of normal breathing mechanism due to nasal congestion, sinuses, allergies, sleep apnoea, anatomic structural variation in nose and soft palate or alcohol consumption cause snoring.

Hoarse, harsh sound from nose or mouth that occurs when breathing is partially obstructed from above causes during sleep is termed as snoring. Snoring is an involuntary response to an external stimulus that causes airway obstruction. Shoring is considered a distraction, a disturbance to family members of the person who continue to snore at night. This kind of habitual loud snoring affects a quarter of adult population. Situations arise when it becomes inevitable to undergo a procedure to stop snoring.

A person with chronic airway obstruction when doses to sleep, the muscles in the soft palate, tongue and throat relax. The increase in airway obstruction forces the air to cause vibration of tissues that lead to loud snoring.

The airway obstruction that cause snoring occurs in following conditions.

ANATOMY OF MOUTH – People with low thick narrow palate can obstruct air flow in the upper respiratory tract. If a person has an elongated uvula it leads to obstruction of air flow producing loud vibration that lead to snoring. Obese people have extra tissue in the back of throat that narrow airways causing obstruction and snoring.

ALCOHOL CONSUMPTION – People who consume alcohol before going to bed experience relaxation of throat muscles inhibiting  natural defines action, producing airway obstruction. This develops snoring.

NASAL DEFECTS – Deviated nasal septum or congestion of nasal passage, obstruct normal flow of air causing snoring.

DEPRIVATION OF SLEEP or lack of adequate sleep after strenuous work can also cause snoring.

What condition commonly associated with snoring?

Obstructive sleep apnoea is a condition when patient experience slow breathing pattern or at times it stops at least five times during every hour of the sleep. A loud snoring is observed in people who suffer from obstructive sleep apnoea. After a loud snoring there is a brief period when breathing ceases and stops. Patient wakes up with loud gasping sound when the breathing stops suddenly. This clinical condition is associated with sore throat, excessive sleepiness during day time, chest pain and headaches.

A patient with obstruction while breathing with snoring having high blood pressure, obesity, nasal problems should consult a doctor.

A doctor will treat the symptoms from a specific diseased condition. A patient is examined thoroughly by an ENT surgeon or an otolaryngologist to determine size, shape of patient’s uvula, soft palate, nasal cartilage and throat muscles that are responsible for producing snoring. A nasopharyngoscope is a diagnostic aid to study palate using a fibre optic device. CT scan and MRI are other imaging techniques that are done by a doctor before a snoring surgery is planned.  A doctor after examining at length every minute structure or parts of buccal cavity, may later advise a surgery or UVULOPALATOPLASTY to eliminate snoring, post a detailed physical examination.

What is UVULOPALATOPLASTY?

Uvulopalatoplasty is a surgical procedure done with an aim to reduce or withdraw snoring. Uvula is a small cone shaped projection that hangs from the top of inside of mouth just above the throat. During sleep uvula vibrates, can block the air flow into the lungs causing obstructive sleep apnoea and loud snoring. An uvulopalatoplasty done to remove uvula, is a surgical procedure to eliminate or prevent snoring.

Uvulopalatoplasty was first developed in 1980s by a surgeon in Paris in France. Surgeons now claim that it is a successful treatment procedure to cure obstructive sleep apnoea and snoring.

Uvulopalatoplasty is an outpatient surgical procedure done by means of laser to remove parts of uvula at the upper corner of the mouth.

The procedure takes up to 30 minutes with three to five visits to the consulting physician.  It is done under local anaesthesia. Patient is allowed to do normal routine functions after the operation.

What are different methods to do uvulopalatoplasty?

UVULOPALATOPLASTY is a surgery to remove or cut the tissues near uvula and palate. It is mainly done when the certain other procedures are not very effective in treating snoring. Patients who have long uvula and extra tissues surrounding the tonsils called as posterior tonsillar pillars. These may be long enough to cause vibration or flutter during sleep causing a loud snoring sound. The surgeon removes parts of these elongated tonsils, parts of soft palate and uvula. The airway is enlarged and soft tissue that causes vibration producing snoring is removed. However, this method has one major complication that it causes severe bleeding.

 There are other types of uvulopalatoplasty procedures performed in outpatient clinic to minimise risk of these complications. These treatment procedures are done to remove medical and social causes of snoring.

CAUTERY ASSISTED UVULOPALATOPLASTY – is a surgery of the palate done to treat snoring from obstructive sleep apnoea or simple snoring without any diseased pathology? Local anaesthesia is given to the patient without any sedation. This procedure involves a combination method of removal of the tissues and tightening of nearby tissues using cauterisation. It is done by controlled cauterisation of scar tissue which shrinks soft palate slightly. This process aims to increase the size of airway passage without disturbing normal functions such as breathing, speaking and swallowing.

Certain risks are involved in cautery assisted uvulopalatoplasty like bleeding. Patients are at a risk of getting infections. Antibiotics are prescribed to treat infection and swelling. There is a possibility that regurgitation of ingested food and water may take place. This may eventually reduce or stop once the swelling due to is treated.

Changes in speech are often observed with dryness of throat and feeling of obstruction.

In order to avoid above complications, painkillers are prescribed by the physician. Holding ice in mouth for reduces the swelling and pain. Patient is asked to take nutritive diet with lots of fluids. Patient is advised to sleep with head elevated and restrict physical activity for 3 weeks.

LASER ASSISTED UVULOPALATOPLASTY is a treatment for snoring by using carbon dioxide laser. It reshapes superficial tissues of the palate. It is performed in 3 to 7 sessions between 3 to 4 weeks interval. The advantage of this surgery is that it does not remove tonsils and lateral wall phargengeal tissues, only that much tissue is scraped that eliminates snoring. This method is not recommended nor is done more often in clinics as it has several complications.

RADIOFREQUENCY VOLUMETRIC TISSUE REDUCTION is a procedure where surgeon uses a thin needle attached to a source of radiofrequency signals to shrink the tissues of soft palate, throat or tongue. The needle is inserted underneath surface of the cells, heated to a temperature of 70 degree C or 80 degree C. The heated tissue gets shrined which gets absorbed by the body within next 4 to 6 weeks. The total volume of the tissue relatively reduces thereby the vibrations producing a snore are removed. It takes up to 30mins to complete this procedure under local anaesthesia.

TONGUE SUSPENSION PROCEDURE called as a Repose system is a minimal invasive surgical procedure to treat snoring that stabilizes the base of the tongue during sleep. It consists of titanium screws inserted into lower jaw on the floor of the mouth with a suture passed at the base of the tongue, which is then attached to the screw.  It is an FDA approved system and this type of attachment holds tongue forward during sleep.

INJECTION SNOREPLASTY is done using a hardening agent called sodium tetradecyl sulphate beneath the skin of roof of mouth in front of uvula. This chemical hardens into blister formation that causes scar formation. This scar tissue pulls the uvula forward reducing the vibration that cause snoring.

The surgical treatment for snoring is most suitable and effective to patients who suffer from nasal obstruction.

Patients who do not wish to undergo any surgical procedure can seek other alternative methods.

Snoring disturbs and annoys people and relatives of the person who has a habitual pattern of snoring.  It may be a serious medical condition.

There are few remedial solutions that may help to overcome snoring. 

An obese patient should lose weight by reducing the amount of high calories in diet and exercise. It helps to reduce the tissues or fats surrounding throat muscles that cause snoring.

Sleeping on your side will allow an easy flow of sir rather than sleeping on back that may cause tongue to move on back of throat that lead to vibration producing snoring.

Elevate your head on the pillow up to 4 inches that may reduce snoring by creating a passage for airways.

Nasal strips or nasal dilators helps to increase space in the nasal passage. This allows easy flow of air and aids in breathing process.

Alcohol consumption should be avoided.

Anatomical and structural problems like deviated nasal septum should be treated.

Chronic allergies that block nose, create obstruction to normal breathing process should be given prime urgent medical attention.

People should avoid sedatives and smoking.

Adequate sound sleep of up to eight hours is a must that help to reduce snoring.

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