Snoring surgery: Which one is best for you? - Statistical Data Included

Ear, Nose & Throat Journal, Nov, 1999 by Philip D. Littlefield, Eric A. Mair

Another problem is that there is little agreement on what constitutes a successful outcome. Some authors define success as "improved to absent snoring," while others call it "absent or markedly reduced snoring." Using the former definition will interject bias into a study toward a better outcome, as is evident in the literature.

Until these issues are resolved, it will remain difficult to quantify the true outcome of UPPP or any other snoring procedure. Nonetheless, in the largest long-term UPPP study to date, only 46% of patients said that they had stopped snoring or that their snoring was markedly improved (i.e., their bed partner was infrequently awakened). [15] There is little doubt that many UPPP patients do not obtain adequate relief of their snoring.

In addition to relieving snoring, UPPP alleviates EDS. In one long-term study of 51 patients who initially complained of EDS, 73% later said that their EDS had been completely or markedly alleviated. [16]

Few studies have specifically addressed UPPP's complications. Of the four major studies that did, all included patients with OSAS, and only three estimated the prevalence of any complications. Of these three studies, the two largest were retrospective, while the other was a smaller prospective series. The most serious perioperative complication was a 2 to 11% incidence of postoperative airway obstruction that resulted in an approximately 1% perioperative mortality. [21-23] One group reported a 5% incidence of difficult intubation, but they correlated that incidence to the severity of OSAS. [21] Postoperative bleeding serious enough to require a return to the operating room occurred in 2 to 5% of cases. [21-23]

Clinical experience indicates that UPPP is often complicated by severe postoperative pain. Few studies have attempted to quantify this. In one series, 86% of patients were satisfied with the outcome of their procedure, but in retrospect, because of the pain, only 60% said they would undergo the same treatment. [21]

The most common long-term complications are velopharyngeal incompetence (VPI) and palatal dryness. Temporary postoperative VPI occurs in most patients, and studies have reported that 10 to 24% of patients continued to complain of intermittent nasopharyngeal regurgitation 1 year after surgery. [22,23] In the same studies, up to 31% of patients complained of persistent palatal dryness. [22,23] Less frequent long-term complications include nasopharyngeal stenosis, long-term voice changes, and a partial loss of taste. [22-24]

In addition to all its limitations, UPPP is expensive. Costs vary widely among institutions, but the procedure, the anesthesia, and 1 night of postoperative monitoring in an intensive care unit can cost in excess of $10,600. [6]

Laser-assisted uvulopalatoplasty

The limitations of UPPP created a demand for a more effective, safe, economical, and comfortable alternative. In 1986, the French surgeon Kamami used a [CO.sub.2] laser for a procedure initially called laser vaporization of the palatopharynx. It was similar to the standard UPPP except that the tonsils were not removed, and it was performed in several stages under local anesthesia. Kamami's initial results, published in 1990, were encouraging, as the short-term success rate was 97%. [25] Coleman introduced the procedure to the U.S. in 1992, but by then it had been modified and was called the laser-assisted uvulopalatoplasty (LAUP). [26]