UPPP and Tonsillectomy

The uvulo-palato-pharyngoplasty (UPPP) and tonsillectomy are often performed as a part of Obstructive Sleep Apnea surgery. The UPPP procedure shortens and stiffens the soft palate by partial removal of the uvula and reduction of the edge of the soft palate. Since there may be other sites of restriction to breathing, such as the tongue base, the UPPP and tonsillectomy may not resolve the OSA. Most patients who snore, but do not have apnea should enjoy a dramatic decrease in loudness of snoring after UPPP.

Complications of the UPPP procedure are not common, but merit discussion. The palate is a valve which separates the nose from the mouth. This valve is like any other in that it may be broken and stuck in an open or closed position. A palate that no longer completely seals the nose from the mouth has the sound of excess nasal tones and possible leakage of liquids out of the nose. On the other hand, rare instances of severe scarring of the palate could potentially worsen the OSA and make speech unusually non-nasal sounding. Care is taken to avoid either complication by judicious planning and careful technical execution of the procedure. Some patients do note a foreign body feeling when they swallow after having had a UPPP and is due to scar formation.

The tonsillectomy can be an important component of surgery for OSA, especially if the tonsils are at all enlarged. The removal of redundant tissue by tonsillectomy increases the caliber of the throat thereby reducing blockage to breathing. Since the quality and quantity of tissue of the throat changes after tonsillectomy there can be a subtle alteration in voice quality. In a mature adult, pain following tonsillectomy can be unpleasant, but is reasonably well controlled with prescription medication. The UPPP and tonsillectomy remain a very important part of surgery to expand the upper breathing passage for treatment of OSA.