UVULOPALATOPHARYNGOPLASTY VS LASER-ASSISTED UVULOPALATOPLASTY - ANATOMICAL CONSIDERATIONS

Objective: To assess and compare anatomical changes in the velopharynx produced by conventional uvulopalatopharyngoplasty and by laser-assis ted uvulopalatoplasty. Design: A before-after trial of patients who un derwent conventional or laser-assisted palatal surgical procedures. Pa tients and Interventions: A total of 174 patients (157 men and 17 wome n; age range, 22-71 years; mean age, 48 years) who were suffering from heavy snoring (n=16) or obstructive sleep apnea. The first 100 consec utive patients underwent conventional uvulopalatopharyngoplasty, and t he remaining 74 underwent 1 of 2 surgical variations of laser-assisted uvulopalatoplasty. Main Outcome Measures: Preoperative and postoperat ive examinations included peroral photographs of the oropharynx and na sopharyngoscopic examination of the velopharyngeal valve. In 10 random ly selected patients, postoperative lateral and frontal cephalometric radiographs, enhanced with contrast media, were compared with routine preoperative radiographs. Results: Uvulopalatopharyngoplasty results i n an enlargement of the oropharynx and an increased velopharyngeal air space. Laser-assisted uvulopalatoplasty, by producing a raw surface, involves circumferential scarring, the severity of which depends on th e velopharngeal axial configuration; therefore, it can result in a dim inished velopharyngeal air space and decreased distensibility. Conclus ions: From an anatomical viewpoint, laser-assisted surgery of the pala te is significantly inferior to conventional uvulopalatopharyngoplasty and may even be deleterious. The results of preoperative and postoper ative polysomnographic comparisons in patients who undergo laser-assis ted operations should be evaluated to determine whether future laser-a ssisted surgery is an adequate option, even for snoring as an isolated symptom.