Modified Uvulopalatopharyngoplasty: The Extended Uvulopalatal Flap

A modified uvulopalatopharyngoplasty (UPPP)- extended uvulopalatal flap (EUPF) was performed for the treatment of obstructive sleep apnea (OSA). Thirty-three consecutive patients with OSA underwent EUPF that consisted of bilateral tonsillectomy, dissection and removal of submucosal adipose tissue of the soft palate and supratonsillar area, imbrication and reposition of the denuded uvulopalatal flap.  Variables of polysomnography (PSG) included respiratory disturbance index (RDI), snoring index (SI) and minimal oxygen saturation (MSAT).  Surgical success was defined as achieving the postoperative RDI to less than 20 events per hour and a greater than 50% reduction of the preoperative RDI. Six months after operation, twenty-seven patients (81.8%) responded successfully.  The mean RDI decreased from 41.6+28.2 to 12.5+18.1(P<0.0001), and the mean MSAT and SI improved significantly (P<0.0001).  The postoperative sequelae were transient with 3% of persistent nasal regurgitation. The results in this series revealed EUPF improves OSA with minimal adverse effect in selected patients and this technique suggests a role of fat dissecting in the palatal surgery for OSA.

Extended uvulopalatal flap in the treatment of obstructive sleep apnea – results of sleep and three-dimensional computed tomography

OBJECTIVES: To demonstrate the operative technique of extended uvulopalatal flap (EUPF), and to evaluate its effectiveness for the treatment of obstructive sleep apnea (OSA).

STUDY DESIGN: Fifty patients with OSA underwent EUPF that consisted of bilateral tonsillectomy, dissection and removal of submucosal adipose tissue of the soft palate and supratonsillar area, imbrication and reposition of the denuded uvulopalatal flap.  . Polysomnography (PSG) was accomplished with Three-dimensional computed tomographic scan (3-D CT) at the baseline and 6 months after operation. Good responders were defined as achieving the postoperative RDI to less than 20 events per hour and a greater than 50% reduction of the preoperative RDI.

RESULTS: Forty-two patients (84%) were good responders. The respiratory disturbance index and minimal O₂ saturation improved significantly (P<0.0001) after EUPF. The changes on 3-D CT were significantly increased in retropalatal space (P<0.0001).

CONCLUSION: EUPF based on the removal of palatal fat was verified to be effective in the reduction of sleep apnea in selected patients. 3-D CT confirmed this technique is effective in the widening of upper airway and relieving the retropalatal obstruction.

Changes in Quality of Life and Respiratory Disturbance after Extended

Uvulopalatal Flap Surgery in Patients with Obstructive Sleep Apnea

Objective: To evaluate the subjective and objective outcomes of extended uvulopalatal flap (EUPF) surgery in patients with obstructive sleep apnea.

Design:  Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Snore Outcomes Survey (SOS), Epworth Sleepiness Scale (ESS), and polysomnography were performed preoperatively and then six months postoperatively

Setting: A tertiary care, sleep disorders referral center.

Patients: Fifty-five consecutive patients (52 men, 3 women; mean age, 45 years) with obstructive sleep apnea.

Intervention: extended uvulopalatal flap.

Main Outcome Measures: Parameters of overnight polysomnography included: respiratory distress index (RDI), snore index (SI), minimum oxygen saturation (MSAT), sleep stage 1 and 2, 3 and 4, rapid eye movement, and sleep efficiency. Parameters of questionnaires included scores of SF-36, SOS, and ESS. Success of operation was defined as a ＞50% reduction of the RDI from the initial value and a postoperative RDI of <20.

Results: The overall success rate of EUPF was 81.8%; the RDI, SI, and MSAT improved significantly after surgery (P<0.0001). Sleep architecture in overnight polysomnography remained unchanged (P>0.05). Patients demonstrated significant improvement in both their SOS and ESS scores (P<0.0001) and significant increases in 7 out of 8 SF-36 subscales (P<0.05). However, there was poor correlation between the improvement in quality of life and the reduction in sleep-related respiratory events.                

Conclusion: EUPF can greatly reduce sleep-related adverse events and proves to be an effective therapy to enhance the quality of life of patients with OSA. This study also suggests that subjective and objective outcomes are equally important when reporting the results of EUPF surgery.