How is uvulopalatopharyngoplasty (UPPP) performed?

Updated: Dec 09, 2020
  • Author: Eelam Aalia Adil, MD, MBA; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Surgery begins with removal of any tonsillar tissue. A tonsil is grasped with a curved Allis clamp and retracted medially. Bovie electrocautery is the most commonly used instrument for this procedure, but coblation and cold steel are also commonly used. [17]

The anterior tonsillar pillar mucosa is incised just lateral to its reflection onto the tonsil. Dissection proceeds along the tonsil capsule in an avascular plane until the entire tonsil is removed. A similar procedure is used to remove the contralateral tonsil.

Attention is then turned to the soft palate. The aim of this portion of the surgery is to resect the inferior portion of the soft palate along with the uvula in a skiving fashion such that more nasopharyngeal than oropharyngeal mucosa is preserved.

A horizontal incision is made along the soft palate mucosa just anterior to the uvula and connected to the superior edge of the previously made anterior pillar mucosa incisions. The incision is carried down through the mucosa to the tensor veli palatini muscles. Beveled dissection proceeds towards the uvulae muscle until the redundant soft palate and lateral pharyngeal mucosa is resected.

Hemostasis is achieved using electrocautery. Different suturing techniques and materials have been described. For example, 2.0 Vicryl sutures may be used in a horizontal mattress fashion at the corners of the soft palate to bring the nasopharyngeal and oropharyngeal mucosa together in a single layer. The knot of the suture is placed on the oropharyngeal surface. Several interrupted stitches or running sutures are then used to reapproximate the remainder of the soft palate mucosa. The inferior-most tonsillar fossae mucosa is left open in case of postoperative bleeding.

For post-operative analgesia, 6-10 mL of 1% bupivacaine in 1:200,000 epinephrine is then injected into each tonsillar pole and the soft palate. During injection, extreme care should be taken to withdraw prior to injection to avoid intravascular injection of bupivacaine with resultant severe complications, including cardiovascular collapse.

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