Snoring is the sound of a narrow airway vibrating during sleep. In many people the narrowing is at the soft palate: the flexible back part of the roof of the mouth, with the uvula hanging from it, flutters against the throat with every breath. When the airway closes completely for seconds at a time, the condition is obstructive sleep apnoea, which fragments sleep, exhausts the person during the day and strains the heart over years.
Uvulopalatopharyngoplasty, usually shortened to UPPP, is surgery to widen the airway behind the palate. It removes excess tissue from the soft palate and the uvula, takes out the tonsils if they are present, and reshapes the side walls of the throat so that the space stays open in sleep.
Choosing the right patient
UPPP has a mixed reputation because for years it was offered to everyone who snored, whatever the cause. It works well for the right patient and poorly for the wrong one. Dr. Teker therefore begins with a sleep study, which measures how severe the apnoea actually is, and an examination of the whole airway, sometimes with an endoscope during drug-induced sleep, to see whether the collapse happens at the palate, at the base of the tongue, or both. The nose is examined too: a deviated septum or enlarged turbinates make snoring worse and are corrected first or in the same operation.
Good candidates have mild to moderate apnoea with obstruction mainly at the palate, a reasonable body weight, and either an inability to tolerate CPAP (an air-pressure mask) or a strong preference for a surgical option. For severe apnoea, CPAP remains the most reliable treatment; surgery can make it easier to use but rarely replaces it.
Modern technique
The older operation simply cut tissue away, which sometimes left a stiff scarred palate and problems with swallowing. Current techniques, grouped under the name pharyngoplasty, reposition the palate and the muscles of the side walls forward and outward with sutures, so that the airway is widened while as much tissue as possible is kept. The uvula is trimmed rather than removed. Dr. Teker adapts the technique to the individual throat.
Recovery
Expect a sore throat for about ten days, similar to a tonsillectomy, with regular painkillers, cool fluids and soft food. Swallowing feels different at first, and a little fluid may escape into the nose for a week or two while the palate heals. Most patients return to work in two weeks. The final result is judged at three months with a repeat sleep study.
Keeping the result
Snoring can return with weight gain, alcohol in the evening or a blocked nose. A stable weight, a clear nose and, where needed, continued use of a mandibular device or CPAP help protect what the surgery achieved.