Radiofrequency-Assisted Uvulopalatoplasty with Tonsillectomy for the Treatment of Mild to Moderate Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: In radiofrequency surgery, energy is usually delivered to the submucosal tissue of the palate through a special probe in order to reduce the volume and rigidity (palatal channeling). However, the same probe can be used to make cuts in the free edge of the soft palate, as in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. The objective of the current study was to evaluate the role of RAUP with tonsillectomy for the treatment of mild or moderate obstructive sleep apnea (OSA). MATERIALS AND METHODS: Eighty-two patients with mild to moderate obstructive sleep apnea (5< or =AHI<30, BMI<30) were included in this clinical trial. All patients received RAUP with tonsillectomy. Patients were followed for six months and were asked to respond to a questionnaire regarding standard visual analogue score pattern. Assessment was performed prior to the surgery and was repeated six month postoperatively. Visual analogue scores were measured for the parameters of pain, speech deficits, dysphagia and snoring (according to the partner). The Epworth sleepiness scale (ESS) was also utilized. Polysomnography was conducted preoperatively and was repeated six months postoperatively. RESULTS: There were significant differences in improvement of snoring, ESS and AHI before and after the procedure, and the success rate of the surgical treatment was 62%. Postoperative pain, speech disturbance, dysphagia were decreased two weeks after the operation. CONCLUSION: The results of the study suggest that RAUP with tonsillectomy is an effective treatment for patients with mild to moderate obstructive sleep apnea.

Outcome of laser-assisted uvulopalatoplasty (LAUP) in the management of snoring in Hospital Universiti Sains Malaysia (USM)

To determine the outcome of laser-assisted uvulopalatoplasty for the management of patients with snoring in Universiti Sains Malaysia Hospital (HUSM). A retrospective review of patients who underwent LAUP with or without tonsillectomy or adenoidectomy under general anaesthesia between December 2003 to December 2006. Data was obtained from admission and follow-up records in the otorhinolaryngology clinic of USM Hospital (HUSM). A total of nineteen patients underwent procedure for the treatment of snoring. Majority of these patients presented with symptoms of loud snoring and daytime somnolence. The main operations performed were LAUP with or without tonsillectomy or adenoidectomy. The justification for LAUP were overhanging and excessive uvula or soft palate, whereas for adenotonsillectomy were the hypertrophied adenoids and tonsils. On follow-up, most of the patients claimed improvement of snoring within the first 2 months post-operation. However, majority of them defaulted follow-up after that. One patient (AHI preoperatively was mild) was reviewed up to 8 months with no snoring. One patient (AHI was severe preoperatively and normal post operatively) remained in our follow-up was satisfied with the operation. Two patients continued to experience snoring post LAUP despite trial of non-surgical methods. The outcome of LAUP in our patients showed variable results. This showed that patient selection is very important to achieve good result in LAUP. Long-term follow-up is also essential to document the success for LAUP.

Paradoxical Upper Airway Obstruction and Central Sleep Apnea Developed After Anterior Cervical Spine Fusion / 결핵및호흡기질환

We report a case of a 48-year-old man with a paradoxic upper airway obstruction and central sleep apnea that developed after an anterior cervical spinal fusion. Nine months before being admitted to this hospital, he was diagnosed with a herniated intervertebral disc between the 5th and 6th cervical spine, and the first operation was carried out. Two months later, a pseudoarthrosis has developed and a second operation, an anterior interbody fusion of the C5 and C6 using autogenous strut bone graft, was performed. After the second operation, he began to complain of snoring, excessive daytime sleepiness, insomnia, and a bizarre sound heard near the upper airway during breathing. Nasopharyngoscope and magnetic resonance imaging disclosed a paradoxical narrowing of the nasopharynx during expiration. On the overnight polysomnography, the apnea index was 8.7/h (central apnea, 7.0/h; obstructive apnea, 1.7/h). Nasal continuous positive airway pressure was applied, but he complained of pressure-intolerance, and laser-assisted uvulopalatoplasty was then performed. Two months after surgery, clinical symptoms as well as the apneas had improved markedly. We suggest that this paradoxic upper airway obstruction might be associated with the anterior cervical spinal surgery even though the mechanism is unclear. This case also emphasizes that an upper airway obstruction can contribute to the development of central sleep apnea.

An Acoustic and Radiologic Study on Voice Change after Laser Assisted Uvulopalatoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many people have been concerned about voice change after laser assisted uvulopalatoplasty (LAUP). A number of studies reported acoustic changes after uvulopalatopharyngoplasty (UPPP) and LAUP. However, there have not been any reports on the association between anatomic change and acoustic results after LAUP. The purpose of this study is to analyze changes in the voice and changes in the vocal tract after LAUP and to evaluate whether the anatomical changes of vocal tract have an effect on the voice change or not. SUBJECTS AND METHOD: By using CSL, we analyzed fourteen LAUP cases on the formant frequencies of six vowels (/a/, /i/, /u/, /=, /o/, /e/) and four nasal consonants (/hana/, /eomma/, /eoungga/, /chiken/). By using MR image, we analyzed changes in the vocal tract eight weeks after LAUP with preoperative findings in three cases. RESULTS: In acoustic analysis, the second formant frequencies of /u/ and /= phonation were significantly reduced postoperatively compared to those of preoperative status. In imaging study of /u/ and /=, the uvula and soft palate were contracted, so coupling was occurred between nasal cavity and oropharynx in /u/ and /= phonation and the tongue was shifted toward posterior pharyngeal wall to compensate coupling. CONCLUSION: LAUP reduced the second formant of /u/ and /=, which did not result in serious voice changes.

Conventional, Laser-Assisted and Coblation-Assisted Uvulopalatopharyngoplasty/Uvulopalatoplasty: Their Advantages and Disadvantages / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is performed conventionally with cold knifes and electrocautery under general anesthesia. Although laser-assisted uvulopalatoplasty (LAUP) reduced the need of general anesthesia and bleeding, it still has such problems as severe pain or scar contracture. Coblation electrosurgery is known to be less painful by thermal ablation with low heat. However, comparative studies on the merits and demerits between various surgical techniques are lacking. The aim of this study is to evaluate the advantages and disadvantages of each surgical method by comparing the surgical outcomes between conventional UPPP and Coblation-assisted UPPP (CUPPP), and between LAUP and Coblation-assisted uvulopalatoplasty (CAUP). MATERIALS AND METHOD: Conventional UPPP (N=25) and CUPPP (N=18) were performed on 43 patients with obstructive sleep apnea (OSA), and LAUP (N=21) and CAUP (N=7) on 28 patients with mild OSA or snoring, respectively. Postoperative subjective degrees of apnea, snoring and pain, operation time, amount of intraoperative bleeding and episodes of delayed bleeding were compared between the two groups. RESULTS: Early postoperative pain and intraoperative bleeding were observed less in the CUPPP group than in the conventional UPPP group. Operation time was shorter and intraoperative bleeding was less in the LAUP group than in the CAUP group. Early postoperative pain was less in the CAUP group than in the LAUP group. CONCLUSION: Thorough knowledge regarding advantages and limitations of different UPPP or uvulopalatoplasty methods is required for clinicians to make appropriate use of surgical tools.

The Effect of Midazolam as Premedication for Laser-Assisted Uvulopalatoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Snoring generated at the level of the velopharynx is usually treated with laser-assisted uvulopalatoplasty (LAUP), which is mostly performed under local anesthesia and on an out-patient basis. However, if adequate sedation is not achieved during this procedure, patients may suffer from anxiety, disgusting smell of tissue vaporization, and doctors may even be disturbed by the patients gagging or repetitive swallowing. A relatively new sedative drug, midazolam, is known for its improved safety, effectiveness, more rapid onset of action and shorter life in comparison to the classical sedative agent, diazepam. The authors tried to evaluate the efficacy and safety of intravenous midazolam as a sedative premedication for LAUP surgery. MATERIALS AND METHODS: Thirty-two patients designated for LAUP were divided into three groups by random double-blinded sampling. Each group received an intravenous injection of midazolam (0.05 mg/kg), diazepam (0.1 mg/kg), and normal saline (0.01 ml/kg) 5 minutes before the laser procedure. Vital signs were monitored before, during and after the procedure. Questionnaires about the effectiveness were given to the operator and the patients, and the scores of the three groups were compared statistically. RESULTS: Vital signs were stable in all three groups throughout the entire procedure. Midazolam showed better sedative effect than placebo and diazepam. It also showed stronger analgesic and anti-anxiety, and more potent antegrade amnesic effects than placebo. CONCLUSION: Intravenous injection of midazolam is one of the effective and safe ways of premedication for patients receiving LAUP.

Voice Changes after Laser Assisted Uvulopalatoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The subject of voice change after uvulopalatopharyngoplasty (UPPP) has been a challenging issue, because even minor changes in voice quality or articulation may be critical to a professional voice user. A number of studies reported on acoustic changes after UPPP; however, there has not been any reports concerning voice changes after laser assisted uvulopalatoplasty (LAUP), which is a less extensive surgery compared to UPPP. This study was performed in order to analyze changes in the voice quality and nasalance after LAUP, and to provide guidance to professonal voice users who want to have snoring surgery. MATERIALS AND METHODS: In 20 patients (11 male, 9 female) who were to undergo the LAUP surgery, we measured the first and second formants of /a/, /i/, /u/ phonations, and the nasalance in rabbit, baby and mama passage. These parameters were measured preoperatively and also one month after the operation. Postoperative changes were statistically analyzed. Any subjective voice changes were asked to be reported at the visit one month after the operation. RESULTS: The second formant of /u/ phonation was significantly reduced in females. The changes in nasalance, and formants of /a/ and /i/ phonations were insignificant. No one complained of the changes in voice quality, timbre, articulation or speech. CONCLUSION: In general, there were no postoperative changes in nasalance nor any subjective feeling about voice quality after LAUP. However, changes in formant characteristics of certain vowels warrant clinicians to be more cautious in recommending LAUP for professional voice users.

LASER ASSISTED UVULOPALATOPLASTY IN SNORING PATIENTS

Habitual snoring is common among males, especially among those who are overweight, and gets worse with the age. Snoring Is related to physical obstruction of breathing during sleep. This obstruction occurs when the palatal muscles, uvula muscles, and sometimes tonsiles relax during deep sleep and acts as vibrators. We have treated, with laser assisted uvulopalatoplasty(LAUP), twenty patients who suffer from snoring. CO2 laser was used and approximately I5-30 minutes of operation time was required. There were no singnificant complications, such as bleeding and asphyxia, in the 20 patients treated with LAUP. Results observed in the short term showed that 90% of the patients treated with LAUP considered thems to be essentially improved. Two patients developed scars at the posterior pillars. LAUP is a relatively simple and safe method which is performed at the hospital on an outpatient basis under local anesthesia.