Posted by Captin Cannuck on January 03, 2009 at 13:59:26:In Reply to: Re: Post Surgery - Cant Sleep posted by UPPP patient on January 03, 2009 at 03:45:58:
I am sorry to hear that you are heavy. In my opinion, you have been done a great disservice, as UPPP is not recommended AT ALL for people whose apnea is weight related.
You asked about how UPPP damages the airway.
There have been many mentions of this in medical journals. In some areas in the world (for example, The European Union), you can see that doctors no longer do UPPPs, because of the high rate of complications and poor risk to benefit ratios. If you want to see that, surf European medical sites (for example, google "The Irish Sleep Apnoea Trust", and read about their position on UPPP.
Surgeons have written many articles outlining the hazards of UPPP. For example, Dr. Reginald Goodday wrote an article titled "Treatment of Obstructive Sleep Apnea by Immediate Surgical Lengthening of the Maxilla and Mandible", the surgeon talks about how he needs to do that operation on people who have had damage to their airway from UPPPs.
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QUOTATION FROM MEDICAL JOURNAL:"Clinical examination of patients who have undergone UPPP reveals s soft palate that appears shorter and has a firm scar band on the inferior surfuace. Lateral cephalometric radiographs of these patients reveal that although the soft palate is much shorter, it is also much thicker, which can result in a narrow retropalatal pharnygeal airway. Figure 39-8 [figure shows X-ray of UPPP patient] demonstrates the radiographic soft tissue changes in the drape of the soft palate before and after a UPPP surgical procedure. In this case the retropalatal airway has not improved and the retroglossal airway has, in fact, decreased. These changes can explain why the severity of OSAS actually increases in patients after this procedure. Because UPPP is often performed as the first line of surgical treatment for OSA despite its high failure rate, the oral and maxiloffacial surgeon neeeds to regularly perform orthognathic surgery on these patients to correct the underlying skeletal deformity contributing to the patient's OSA. In theory, the altered pharnygeal anatomy may compromise this surgery by limiting the advancement and the patient could also be at risk of velopharnygeal insufficiency. Because of this concern and to provide information to these patients regarding of maxillomandibular advancement (MMA) surgery, Robertson and Goodday reviewed 14 patients treated my MMA for OSAS who had unergone previous UPPP. MMA produced significant reductions in excessive daytime sleepiness, snoring and witnessed apnea without long-term nasal regurgitation or change in speech. In this study, twice as may subjects stated that teh UPPP was a more painful procedure than MMA. When asked if they would undergo UPPP or MMA again, all subjects reported that they would undergo MMA again. Only one subject would undergo UPPP again; however, this patient indicated that he felt that UPPP decreased the frequency of sore throats buy had no effect on his OSAS."
See: Robertson CG, Goodday RH. Risks and befefits of maxillomandibular advancement in OSAS patients with previous UPPP. J Oral Maxillofac Surg 2002;60(8 Suppl):64
*********************************************************************I have been told from many surgeons who examined me that scar tissue formation following my UPPP has resulted in a second tightening-action after the initial surgery. It made my airway smaller. An analogy is that you take a pair of blue jeans to the tailor and ask him to remove some material; that is like UPPP. The surgeon thinks that your airway looks more firm and less flappy. He thinks the surgery is a success. Then, going back to the blue-jeans analogy, you take the pair of blue-jeans from the tailor, and put them in the dryer on the "cotton" setting. You try them on, and you discover that they are now too tight; that is like how scar tissue has a second action pulling tighter after the surgery.