Posted by seattlebill on April 30, 2008 at 18:03:58:In Reply to: To UPPP or not to UPPP... posted by shogun on April 28, 2008 at 16:34:22:
Hey guys, I'm Back !
1) I'm not biased against the UPPP. However, I see it as a niche procedure that shouldn't be looked upon as a cure. The effects are very temporary in those who do benefit as the soft tissue tends to have a degree of laxity and plasticity. In those people who are larger or who have large necks, the efficacy in curing or substantially improving OSA in the long run is virtually zero. It is like digging a mineshaft without putting in the wooden shoring. With time (sometimes sooner than expected), the tunnel will re-collapse.
2) A UPPP can generally help in OSA by "debulking" or eliminating a potential area of obstruction. Hence the old-fashioned "staged" surgery approach. It can also help somewhat in justifying to insurance companies the medical necessity and expense of later , more definitive procedures (in that, you've tried everything and have been refractory to all previous treatment).
3). There are some risks to a UPPP beyond the side-effects of pain, foreign body sensation, and retrograde liquid regurgitation. Particularly with the laser version...the LAUP...there is a greater risk of setrimental scarring that can make your anatomy more complicated and your OSA worse !
4) A UPPP DOES NOT always include nor equal a tonsillectomy !! A Tonsillectomy (TA) may be quite useful, and generally NOT potentially harmful as the UPPP. Large tonsils can be debulked as an obstruction to your airway. A TA can therefore be valuable to your treatment plan. However, as an adult, a TA does not generally cure OSA as it does in children !!
If you have issues with your tonsils, you should get a simple tonsillectomy...and NOT a UPPP !
Your poor uvula is just along for the ride. It generally does not cause OSA by itself, and therefore its removal seldom cures OSA. If you wanted, you could get a uvulaplasty and trim your uvula and not trim or "pex" the palate and surrounding walls (which seems to be the root of the side-effects and the poor outcomes that most people experience).
The UPPP only works in a small segment of the population (~20%). When it does work, it can make you a silent apneic...so you need a confirmatory sleep study. When it does work, the effects are often temporary...and perhaps related to transient weightloss that often occurs after surgery.
**Most of us have OSA due to obstruction that occurs at the base of our tongue. The UPPP will not address that with any significance...that is why it is seldom very helpful.
The trach (hole in the windpipe) works because it establishes an airway below all of your obstructions. The MMA/GA works because it physically expands your jaw and pulls your tongue forward establishing a new rigid airway.If you are 5'10" and 240 pounds, regardless of your frame, you have a high BMI and are overweight. Recognizing that losing weight is nearly impossible with severe OSA...you should try to lose 40 pounds ! This may only be possible if you have a succcessful OSA treatment.
The UPPP is doable, however, please don't place high hopes that it will be curative. The TA will probably be the most useful, and the only procedure that you should have to address your tonsillar issues. Then retry CPAP or BIPAP.
I have no bias against the UPPP. However, it truly may not help you.
Good luck,
Bill
- Re: To UPPP or not to UPPP... shogun 01:09 5/01/08 (2)
- Re: To UPPP or not to UPPP... seattlebill 08:03 5/01/08 (0)
- Re: To UPPP or not to UPPP... buckthorn 07:24 5/01/08 (0)