Re: Z Palatopalsty
[Sleepnet.com's Homepage] [Sleep Disorders] [Sleep Links] [Search]

Re: Z Palatopalsty

[ Follow Ups ] [ Post Followup ] [ Non-CPAP Forum24 ] [ FAQ ]

Posted by Captin Cannuck on December 23, 2008 at 09:30:06:

In Reply to: Re: Z Palatopalsty posted by silvergirl on December 23, 2008 at 05:53:03:

I know how you feel. Suffering with sleep apnea is a horrible thing. It really destroys your quality of life. I hope that you will pick the right path; the one which will produce the most long-lasting positive results.

With regard to palate surgeries (UPPP, LAUP, Z Plasty, etc), we must bear in mind that early studies on these procedures were written by the ENT surgeons who did the operations. There was a bias. Often follow up was often undertaken at around the six week mark; too shortly after surgery. Scar tissue is not in "full bloom" at that early point, and thus an overly optimistic outlook was forecast. More realistic studies show that some people may experience impovement, many stay the same, and in others, a deterioration takes place. We also know that when people improved, the improved results were only temporary. They evaporated with time.

As you mentioned, sometimes scar tissue and also removing too much skin can make the airway even smaller than before. Several experts such as Dr. Dement have written that, sleep apnea involves multiple obstructions along the airway. Usually the base of the tongue is the main culprit when it comes to sleep apnea. Dr. L said in the "ask the expert" section that he thinks that there is a design flaw in UPPP, and he went on to say that the uvula is usually not involved in sleep apnea. He has even modified his surgical technique to avoid cutting out people's pharnyx.

Here is some information from an article titled "Treatment of Obstructive Sleep Apnea by Immediate Surgical Lengthening of the Maxilla and Mandible".

"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 maxilofacial surgeon neeeds to regularly perform 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 wish you the best of luck, whatever you do. As least you are informed about the decision and are not under any false pretenses.

Take care.



Follow Ups:


Post a Followup

E-Mail  :  required - same address used when you registered (will not show up in posting)
Password:  required (sent to you when you registered)

Subject : Re: Z Palatopalsty

Comments:....note: including your email address here will result in the removal of your posting (See removal policy)

PLEASE ONLY CLICK THE SUBMIT FOLLOW UP BUTTON ONCE!!. Thanks, Sandman

[ Follow Ups ] [ Post Followup ] [ Non-CPAP Forum24 ] [ FAQ ]