What modifications have been used to minimize the complications of uvulopalatopharyngoplasty (UPPP)?

Updated: Dec 09, 2020
  • Author: Eelam Aalia Adil, MD, MBA; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Complications of uvulopalatopharyngoplasty include nasopharyngeal stenosis, velopharyngeal insufficiency, and globus sensation. To minimize these risks, modifications to uvulopalatopharyngoplasty with uvula preservation have been described. [18, 19, 20] Surgical options include complete uvula preservation or uvular muscle resection with mucosal preservation.

With complete uvular preservation, a larger portion of the soft palate is resected to increase the oropharyngeal airspace. A microscope or loupes can be used to assist with muscle identification. A mucosal incision is made on either side of the uvula and connected with the tonsillectomy anterior tonsillar pillar incisions.

The soft palate mucosa and adjacent adipose tissue are removed, with care taken to preserve the levator and tensor veli palatine muscles. The soft palate mucosa is then closed as described above. Scar tissue contracture eventually gives the uvula a normal appearance and location within the oropharynx.

In uvular muscle resection with mucosal preservation, a horizontal incision is made at the base of the uvula similar to a normal uvulopalatopharyngoplasty procedure. The mucosa overlying the uvula is then undermined and 1–1.5 cm of full-thickness uvula muscle is resected with sharp scissors. The overlying mucosa is then sutured as is a traditional uvulopalatopharyngoplasty.

These modifications may have surgical success rates similar to traditional uvulopalatopharyngoplasty procedures with less postoperative complications.

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