Release: Embargoed until September 24, 2000Contact: Kenneth Satterfield202-371-4517 (9/23-27)703-519-1563[email protected]
THE UVULOPALATAL FLAP, AN OFFICE-BASED SURGICAL PROCEDURE, TREATS SNORING EFFECTIVELY, IN ONE VISIT, AND WITH LESS PAIN THAN LASER TREATMENTS
Washington, DC -- Chronic snoring is a socially disabling problem for a large number of people, and is a frequent complaint presented to otolaryngologists. Snoring can be much more than a simple nuisance, and may signal a more significant sleep-disordered breathing (SDB) problem. SDB encompasses a spectrum of disease, from simple snoring to upper airway resistance syndrome (UARS) to obstructive sleep apnea syndrome (OSAS). All result from partial to complete obstruction of the upper airway. This airway collapse can occur anywhere from the nasal valves to the hypopharynx.
Partial airway collapse and tissue vibration at the level of the palate is the usual cause of the snoring component of SDB. Treatment of the palate is usually very successful in alleviating obstruction at this level and the noise thus produced. In recent years, a number of alternative palatal procedures have been reported for office-based treatment of the palate. These are generally offered for snoring, but some also may have application for more significant forms of SDB. They include laser-assisted uvulopalatoplasty (LAUP), the cautery-assisted palatal stiffening operation (CAPSO), snare uvulopalatoplasty, radiofrequency volumetric tissue reduction (RFVTR) of the palate, and others. All of these treatments attempt to reduce the vibratory component of the soft palate and uvula to reduce snoring. Of these, the LAUP has gained acceptance as the most effective and widely utilized office-based treatment for snoring and OSAS.
In 1996, the uvulopalatal flap, or UPF, was described as a procedure performed in the operating room under anesthesia, and offered several theoretical advantages over traditional UPPP. It is potentially reversible (in case of excessive palate removal), might offer less chance of nasopharyngeal stenosis, and interferes with palatal dynamics less than does UPPP. Its postoperative appearance is virtually indistinguishable from the uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea which is performed under general anesthesia.
This research represents the first attempt to adapt this UPF procedure to an office-based treatment for the palatal obstruction of sleep disordered breathing. The author of the study, "Office-based Uvulopalatal Flap (UPF) vs. Laser-assisted Uvulopalatoplasty (LAUP) in the Treatment of Snoring and Mild Obstructive Sleep Apnea," is Tod C. Huntley, MD, Head & Neck Surgery Associates, Indianapolis, IN. His findings will be presented on September 24, 2000, at the Annual Meeting/Oto Expo of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation, being held September 24-27, 2000, at the Washington, DC Convention Center.
Methodology: The objective of the study was to evaluate the efficacy of the UPF, particularly in comparison to LAUP. Two matched groups of 20 patients with primary complaint of snoring and polysomnographic evidence of mild OSAS only are studied. One group underwent treatment with LAUP and the other underwent UPF. Both groups are compared in regard to changes in snoring, sleep study results, and pain. The potential complications of this technique are also discussed.
Results: Forty patients were treated, 20 in each group. Patients in the LAUP treatment group (17 men, three women) were treated between October, 1997 through June, 1998 and were followed prospectively for treatment outcome. The UPF patients (18 men, 2 women) were treated from January, 1999 through September, 1999 and were followed for the same outcomes measures as the LAUP group. All patients completed the study.
Physical examination of all patients revealed evidence of excessive or redundant palatal and uvular soft tissue, and flexible nasopharyngoscopy revealed central palatal flutter on attempted snorting in all patients. No patient was felt to have significant nasal obstruction as a potential cause for the snoring.
In total, 46 LAUP procedures were performed on 20 patients, for a mean of 2.30 + 1.13 treatments per patient. There was a minimum of one treatment per patient (six patients) and a maximum of five treatments per patient (one patient). In each instance, the decision to proceed with additional treatments was made by the patient, as it was not felt by the examiner that maximum tissue ablation had been achieved with any patient. All 20 UPF patients underwent identical single-procedure treatments, with the only exception that one patient's suture line was closed with chromic while the others were closed with polyglycolic acid sutures.
Criteria used to evaluate efficacy included:
Pain: All subjects from both groups were given prescriptions for a narcotic pain medication (hydrocodone elixir 2.5 mg and acetaminophen 167 mg per 5 ml), and all but one patient (97.5%) took it. The patient who did not require the medication underwent UPF. No patients expressed intolerance to the medication, and no other pain medications were prescribed.
The mean number of days that the LAUP patients took the hydrocodone elixir following each LAUP procedure (mean number of procedures per patient of 2.30) was 12.10, vs. 8.25 days for the UPF group, which was statistically significant. The LAUP patients took a mean volume of 293.25 ml. of the hydrocodone elixir following each LAUP procedure. As these patients underwent a mean number of procedures of 2.3, the patients in this group took a total mean volume of hydrocodone elixir of 597.25 ml. This compares to a mean volume of 228.25 ml. of hydrocodone elixir per patient in the UPF group. This is substantiated by the scores registered by each subject following a procedure indicating the LAUP group incurred more pain.
Snoring: The data revealed that the UPF procedure reduces snoring as well as does the LAUP in this population of patients with significant snoring with no worse than mild OSAS. The two treatment groups did not differ significantly in regard to amelioration of snoring. The study was limited to patients with mild OSAS. LAUP has been studied more extensively in patients with more significant degrees of sleep-disordered breathing. This study presumes, though not proven, that UPF should yield results at least as good as those produced by LAUP for other patients with more significant OSAS. More study is warranted in this regard.
Conclusions: When offered as an office-based procedure for the treatment of snoring, UPF appears to be equally efficacious to LAUP. UPF is significantly less painful than LAUP, in regard to pain severity, narcotic use duration, and total amount of narcotic pain medication required.
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