Minimally Invasive Combined Nd:YAG and Er:YAG Laser-Assisted Uvulopalatoplasty for Treatment of Obstructive Sleep Apnea.

Objective: In this article, efficacy of minimally invasive outpatient laser-assisted uvulopalatoplasty (LAUP) procedure (NightLase® LAUP) to reduce apnea-hypopnea index (AHI) in patients with obstructive sleep apnea (OSA) is evaluated. Background: OSA is a serious condition, but its treatment is often not effective or is poorly accepted by patients. Newer modes of therapy that are more effective and also more accepted by patients need to be developed. The latest treatment approaches involve a minimally invasive LAUP procedure. This procedure involves thermal processing of the relaxed soft palate and surrounding tissues using neodimium-doped yttrium aluminum garnet (Nd:YAG) and erbium-doped yttrium aluminum garnet (Er:YAG) lasers, resulting in favorable collagen shrinkage and development of new collagen fibers. Procedure has previously been reported to safely and effectively reduce snoring, as well as increase the volume of the oropharyngeal airway, and is well accepted by patients. Materials and methods: The efficacy of the minimally invasive LAUP procedure, combining Nd:YAG laser (λ = 1064 nm) and Er:YAG laser (λ = 2940 nm) applied to the soft palate for treatment of OSA on 27 patients with different severities of OSA was evaluated based on AHI measurements before and after only three 20-min sessions in an outpatient setting over a period of 45-60 days. Results: A decrease in AHI for all the patients with different severities of OSA tested in this study was achieved, with 66.3% average improvement (32-100%). Fifty percent or more improvement was achieved in 78% (21) of all patients. Conclusions: Based on our observations, the NightLase® LAUP treatment of OSA represents an effective and safe therapeutic method. Further research and longer term prospective trials are needed to improve the evidence base for the potential integration of this treatment method into the current guidelines for treatment of OSA.

Laser-assisted uvulopalatoplasty (LAUP) complications and side effects: a systematic review.

Objective: Laser-assisted uvulopalatoplasty (LAUP) has been used as a treatment option for snoring and obstructive sleep apnea for almost three decades. It has been previously reported that some patient's sleep-disordered breathing worsened following surgery. The aim of this paper is to further elucidate the specific complications of LAUP. Data sources: A systematic search of the electronic databases MEDLINE/PubMed, Google Scholar, and Embase. Review methods: The PRISMA statement was followed. Databases were searched from inception through September 2, 2018. The following search was applied to MEDLINE/PubMed ((laser AND uvul*) OR (LAUP) OR (LAVP) OR (laser AND (apnea OR apnoea OR sleep))). Results: Forty-two studies with a mean follow-up of 16.1 months reported complications on 3,093 total patients who underwent LAUP. The percentages and associated complications of LAUP are as follows: bleeding (2.6%), candidiasis (0.3%), dryness (7.2%), dysgeusia (0.3%), dysosmia (0.2%), globus sensation (8.2%), surgical site infection (1.3%), velopharyngeal (VP) insufficiency (3.9%), and VP stenosis (1.6%). The mean duration of patient-reported pain in studies that reported pain was 11.65 days. Only globus and VP insufficiency had a significant incidence compared with either the general population or the post-oropharyngeal surgery population with relative risks of 1.48 and 2.25, respectively. Overall, there were approximately 26 complications per 100 patients who underwent LAUP. Conclusion: LAUP is associated with a statistically significant rate of VP insufficiency and globus sensation; however, studies lack details of surgical approaches, suggesting that in a population identified as good candidates, a tissue-sparing approach may result in fewer complications.

Quality of Life Measures Following Laser Assisted Uvulopalatopharyngoplasty (LAUP) in Obstructive Sleep Apnoea Syndrome (OSAS).

The objective of this study is to assess the efficacy of laser assisted uvulopalatopharyngoplasty in the treatment of Obstructive Sleep Apnoea Syndrome. This study was conducted over a period of 2 years and comprised of a total of 18 patients of both sexes, from a pool of 64 patients who presented with clinical features of OSAS. All the surgeries were done by the same surgeon and standardised criteria for diagnosis was followed. Only those Patients who were diagnosed to have moderate to severe OSAS of the obstructive type with single level retro palatal obstruction were treated surgically with LAUP, and followed up for a period of 6 months. Of the 18 patients 16 reported of improvement in quality of life, as assessed by Functional Outcomes of Sleep Questionnaire (FOSQ), accounting for 88.8%. The results support the surgical treatment for OSAS of moderate to severe single level retro palatal type, as evidenced by the FOSQ scoring. LAUP is a very good surgical option in alleviating the symptoms of moderate to severe single level retro palatal OSAS.

Laser assisted uvulopalatopharyngoplasty.

LASER is acronym for Light Amplification by Stimulated Emission of Radiations. Medical laser technology has revolutionized the way surgeries are being done. As laser provide exceptional benefits to the patients it is also called-"A BEAM OF LIGHT FOR THE BENEFIT OF MANKIND". Carbon-dioxide laser is used to excise and vaporize tissue. Surgical injury to the tissue is determined by the power density and spot size. Vaporization is carried out in the defocused mode while cutting or excision is done in focused mode. Laser is being used in almost all parts of the human body. Laser surgery has become the choice of millions world over as it provides exceptional benefits not only to the patients but also to the surgical community. In the last seven years, 195 patients suffering from obstructive sleep apnea syndrome were subjected to Laser Assisted Uvulopalatopharyngoplasty (LAUP). Trimming and reshaping of the Uvula and Palate is done as outpatient. It is like a visit to a dentist. It takes 10-15 minutes per session. The procedure is repeated 3-4 times. Sittings are spaced about 3-4 weeks apart. The patient can go back to work the same day.

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.

Long-Term Polysomnographic Findings and Subjective Results in Sleep Apnea Patients Treated with Laser Assisted Uvulopalatoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laser-assisted uvulopalatoplasty (LAUP) is well established in the treatment of snoring and obstructive sleep apnea syndrome (OSAS), although most reports are based on short-term follow-up results. This study was performed to determine the long-term effects on symptoms and polysomnographic measures in patients with OSAS after 5yrs of LAUP. MATERIALS AND METHOD: Fifty patients with OSAS underwent LAUP, and of these patients, 20 have completed postoperative polysomnographic studies. Questionnaires ranking snoring and apneic symptoms were completed by the patient and bed partner before LAUP. The parameters of measurement were apnea index (AI), respiratory disturbance index (RDI), SaO2, and sleep stages. The statistical analysis was performed using Wilcoxon signed rank test. RESULTS: Subjective questionnaires showed statistically significant improvements in snoring, falling asleep while day work, headache upon wakening. The symptomatic improvement persisted long time. The AI decreased from 15.9 to 10.5, RDI decreased from 23.2 to 14.9, and the mean, lowest O2 saturation increased from 85, 93 to 92, 97 (p<0.05). The RDI was reduced to 10 or less in 40% of patients. CONCLUSION: LAUP is an effective method for the management of mild OSAS. Authors have demonstrated long-term improvement in subjective and polysomnographic measures.

Laser-assisted uvulopalatoplasty and laser uvulopalatopharyngoplasty for snoring and obsrtuctive sleep apnea: Long-term postoperative patient's satisfaction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laser-assisted uvulopalatoplasty (LAUP) and laser uvulopalatopharyngoplasty (Laser-UPPP) are well established and highly successful operation in the treatment of snoring and obstructive sleep apnea (OSA). But, most reports are based on short-term follow-up results. This study was performed to evaluate the patient's satisfaction rate after long-term postoperative follow-up, and to investigate prognostic factors of good surgical outcome, time of recurrence, and sequelae. MATERIALS AND METHOD: 102 patients were operated by LAUP (n=77) and Laser-UPPP (n=25) between Jul,1993 and Dec,1996. These patients were followed up more than 2 years (mean 3.1 years). The degree of snoring and apnea related symptoms were evaluated using questionnaires preoperatively and postoperatively. RESULTS: In 95 (93%) of 102 patients, symptoms were satisfationally reduced in 6 months of surgery. After 2 years the success rate dropped to 68% (70 of 102 patients. In the dissatisfied group 32 patients, most failures occurred between 6 and 12 months after surgery. Prognostic factors of good surgical outcomes were lower preoperative body mass index value, absence of postoperative weight gain, and combined nasal surgery. There was no major postoperative complication, but temporary sequalae ocurred as nasal regurgitation (8.8%), hypernasality (5.9%), pharyngeal foreign body sensation (13.7%), postoperative bleeding (6.9%), and long-lasting pain over 3 weeks (12.7%). CONCLUSION: Long-term follow-up more than 18 months is mandatory to evaluate postoperative results of LAUP and Laser-UPPP. To achieve good postoperative outcomes in the treatment of snoring or OSA, perioperative weight reduction should be recommended, and nasal surgery should be considered in patients with nasal obstruction.

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.