Palate & Pharyngeal Surgery
When most people think of surgery for sleep apnea, they usually know someone who has had a surgery in the back of their throat, usually involving removal of the tonsils and trimming of the uvula and soft palate (the arch of tissue located in front of the back wall of the throat). In the past, many surgeons have tried to eliminate sleep apnea with this single surgery for all patients, which is called a “UPPP”, “UP3” or uvulopalatopharyngoplasty”. Unfortunately, while this helps greatly in some patients, other patients will not benefit much.
Current research shows that the anatomic structure of the soft palate, back wall of the throat (posterior pharyngeal wall), and side walls of the throat (lateral pharyngeal walls) varies greatly from person to person. So, there are MANY different surgeries that can be performed to individually address each person’s collapse of the airway at this level. Some of these procedures are minimally invasive, and designed for snoring. Others address obstructive sleep apnea better. These surgeries include:
1. Expansion Sphincter Pharyngoplasty
3. Transpalatal Advancement Pharyngoplasty
4. Lateral Pharyngoplasty
5. Palatal Radiofrequency Ablation
6. Pillar Implants
How do I know which palate or pharyngeal surgery is right for me?
Dr. Phillips will guide you through the process of choosing the right procedure, based on several factors, including your palate and throat structure and anatomy, any prior surgery you may have had on the throat, your personal preferences and goals, the severity of your sleep apnea, and visualization of your airway during sleep, through sleep endoscopy (link).
Expansion Sphincter Pharyngoplasty
This procedure, which can be performed in a variety of ways, has been more widely studied recently, and has found to be quite effective in addressing both collapse of the palate and side walls of the throat in many patients. The surgery involves first removing the tonsils, then then re-arranging a small palate and throat muscle on each side of the throat with sutures. This acts to pull the palate forward and greatly widen the throat opening. The sutures can be placed in different positions, based on the site where airway collapse is the greatest.
This surgery is performed under general anesthesia, and minimal bleeding is encountered. People undergoing this procedure should expect some difficulty swallowing after surgery for 1-2 weeks while healing, however pain is often well managed with a specialized pain protocol that Dr. Phillips will guide each patient through.
Uvulopalatoplasty describes a group of surgeries that are performed only on the palate and uvula, and are, once again, customized to each patient’s needs, based on their unique anatomy and goals of therapy. For patients with snoring, these surgeries can sometimes be performed in the office, under local anesthetic. However, in the case of more aggressive palatal surgery for obstructive sleep apnea, the surgery may be performed in the operating room under general anesthesia, often in combination with other surgeries to relieve obstruction of the airway.
Surgery on the palate is often performed by making small incisions in the palate, and widening the airway behind the soft palate. Patients often tolerate this procedure well, with only mild to moderate pain.
Transpalatal Advancement Pharyngoplasty
This is a very specific type of surgery that addresses airway collapse in people whose soft palate is very close to the back of their throat, leading to collapse of the palate against the back wall of the throat (posterior pharyngeal wall). Often, these patients have had prior “UPPP” or other palatal surgery.
Dr. Philips performs this surgery under general anesthesia. A curved incision is made at the roof of the mouth, and the tissue at the junction of the hard palate (bony palate), and soft palate is separated under the lining of the palate. A small piece of bone is removed at the edge of the hard palate, and the entire soft palate is sutured (stitched) in a more forward position. This greatly widens the area in the back of the throat. Patients tolerate this procedure well, however some can experience nasal regurgitation temporarily, and the sensation of liquids in the back of the nose when swallowing.
Often combined with other palate or throat surgery, lateral pharyngoplasty is designed to address collapse from the side walls of the throat, after tonsils are removed. Some patients have collapse of the airway primarily at this site, and release and repositioning of the muscles that make up the lateral walls of the throat is very helpful.
Palatal Radiofrequency Ablation
In patients with snoring, this procedure can be commonly performed in the office under local anesthetic. A radiofrequency probe, or palate coblation device, is passed into the palate at key areas to help tighten and slightly shorten the palate. A few treatment sessions may be needed (1-4) to acquire the desired effect. This procedure is best used in patients with snoring or very mild sleep apnea with primary collapse at the palate. The procedure takes about 20 minutes, and people report minimal to mild pain after the procedure.
Pillar Implant Procedure
Another very useful procedure for patients with snoring and upper airway resistance syndrome (UARS), the Pillar Implant procedure consists of placing very small woven implants into key parts of the soft palate. Over the course of months, the body will react with the implants to cause a controlled scarring reaction that stiffens and tightens the palate appropriately, leading to improvement in snoring and obstruction of the airway. The procedure can be performed under local anesthetic in the office, is minimally painful, and takes about 20 minutes. In the right patient, this procedure can have excellent long term results.
However, it is important to note that this technology is often overused by many physicians in patients with more moderate to severe sleep apnea, when it has been shown that these implants rarely address airway obstruction adequately in these patients. Dr. Phillips is very selective in his use of Pillar implants, as patients with snoring and certain palatal anatomy respond the best. Dr. Phillips’s goal is to choose the right procedure for you, based on multiple factors.
Dr. Jeffrey Phillips | Accent Sleep Solutions | 4340 West Newberry Road, Suite 301 | Gainesville, FL 32607 | (352) 271-5375