By: Otolaryngology Associates Dr. R. I. Dickson and Dr. D. R. MintzSnoring, a problem which afflicts millions of people and their partners, occurs when there is obstruction of the free flow of air through the passages of the back of the mouth and nose. This is most often caused by excessive tissue in the uvula and soft palate. Since snoring can be a sign of a more serious condition such as sleep apnea, patients should be fully evaluated by a qualified physician prior to any treatment.
Until now the only surgical alternative to Laser Assisted Uvulopalatoplasty (LAUP) was the more extensive and painful procedure (Uvulopalatopharyngoplasty - UPPP) performed under general anaesthetic in the operating room. The hospital stay could be one to three days, with a recuperative period of at least one or two weeks. Some patients have been reluctant to undergo UPPP solely to treat snoring because it involves significant pain and it is their partner and not them who suffers.
Standard LAUP treatment done in most centers requires three to five treatments to slowly shrink the floppy palate. No tissue specimen is actually removed; the palate is slowly scarred and tightened. Our one step method involves removal of the same amount of tissue as with standard UPPP. The amount of the palate left for normal function is determined by a palatal dimple easily seen in every patient. This dimple corresponds to the lower level of the palatal muscle elevators which are needed for complete closure on swallowing. Preserving these muscles prevents nasal speech or liquid back flow. Our procedure is done in one session in over 95% of cases. We can remove more tissue with no increased pain because we also use a cold laser (not available in the US) and inject cortisone with local anaesthetic.
One step laser treatment is performed under topical and local anaesthetic, with the patient sitting upright and fully awake. The CO2 laser is used to remove the uvula and trim the soft palate, with the treatment taking 20-30 minutes. The average patient will experience a sore throat while eating for seven to ten days, but speaking is not affected. These patients generally return to normal activities immediately afterwards. Snoring is eliminated or significantly reduced in most patients after one session. A second treatment may be required in 5% of patients. Patients usually report a noticeable reduction in their snoring immediately. Further improvement occurs with healing 3-4 weeks postoperatively.
We have 97% patient satisfaction in a series of 220 patients in which patients and their sleeping partners were surveyed 3-6 months postoperatively. 85% of these patients reported a 75-100% elimination of all snoring with one treatment. Most remaining noise was described as heavy breathing only. We have now done over 1,000 patients during the last two years using this one stage method with no serious complications. This extremely safe method is based on the individual palatal anatomy, so the patient is always left with normal speech and swallowing. Patients rarely report temporary back flow of water into the nose while bending over a water fountain. The only negative complaint from a few patients has been a prolonged feeling of increased phlegm which usually disappears over 2-3 months. 90% of our patients miss no work after having the surgery done.
Sleep apnea is caused by a combination of a floppy uvula and soft palate and the tongue falling back to shut off the postnasal space. Surgery to correct this involves removal of the excess soft palate and uvula with the UPPP or one stage LAUP. Since the tongue is part of the problem, not all apneas are cured by removing the extra palatal tissue. However, this type of surgery is the only alternative treatment to using a CPAP (Continuous Airway Pressure) machine for the rest of your life. About one-third of all our procedures have been done on sleep apnea patients. In most cases there is a significant postoperative improvement in daytime sleepiness and feeling of fatigue. Patients must have sleep studies done to establish an accurate diagnosis of sleep apnea.
The one step LAUP technique that we have refined has three major advantages
over standard LAUP. Firstly, only one treatment is usually required, which
produces less overall pain for the patient. Secondly, the cost is dramatically
less. We charge $949.00 Cdn including GST. Canadian residents
only. By removing tissue rather than just shrinking and scarring
it, there is a much greater chance of improvement in cases of sleep apnea.
In patients who have had a previous tonsillectomy or in those with small
tonsils, the postoperative appearance of the palate and throat is identical
to patients who have undergone the more aggressive UPPP procedure specifically
for sleep apnea.
Diagrams of the Procedure:
1. Palate injection sites.
2. Cold Laser Application.
3. Initial Vertical Laser Incisions.
4. Completing Excision Of Uvula And Soft Palate.
Monday to Friday
9:00 a.m. - 5:00 p.m. Pacific Standard Time
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Performed at the Arbutus Laser Centre
Suite 106 - 2025 West Broadway