Comments from the sleepsurgeon
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Comments from the sleepsurgeon

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Posted by sleepsurgeon on March 05, 2009 at 17:07:47:

Instead of answering questions from each thread, I am going to post comments from selected threads and see how it works out.

Communication between the patient and the surgeon is the KEY in establishing a relationship. The old days of the cold, arrogant, instrument throwing surgeon is long gone. The patient and the surgeon are on the same team and are working together to find the best way to tackle a medical problem. If patients have concerns about their treatment, they should discuss them with the surgeon. Having that said, I freely admit that I have been impatient at times, when the same questions were asked repeatedly despite answering them numerous times. Poor communication leads to misunderstanding, distrust, poor outcomes and dissatisfied patients. I have declined offering surgery when I think there is a communication problem with the patient.

When an UPPP is done properly (I refer you all to my past posts on how the procedure should be performed to avoid complications), there should not be any voice changes. Obviously, the same goes for MMA. When MMA is done in patients already had UPPP, there can be a slight increase risk of voice changes IF THERE HAS BEEN AGGRESSIVE TISSUE REMOVAL. I did a study and published it many years ago to look at this particular issue and did not find any speech problems in the patients evaluated. In my practice, I would tell patients if I think there is a risk of slight hypernasality with MMA when the palate has been significantly reduced. It has not been a problem though.

LAUP is the worst kind of UPPP and I believe that it should never be done. It causes more scarring than a traditional UPPP (which is already very bad). The complication associated with UPPP is actually airway stenosis or narrowing of the airway and hypernasality should not occur. MMA in the presence of a soft mucus cleft should not cause hypernasality either. There may be anatomic factors that led to the speech issue but I will not be able to comment without an examination and fiberoptic airway evaluation.

Finally, I know some surgeons would perform pharyngeal surgery such as UPPP/tonsillectomy with MMA. I have written about it in the past and I think it is a BIG mistake. The incidence of post surgical bleeding following UPPP/tonsillectomy in the first two weeks is 1-4%. Following MMA, patients have limited mouth opening and gaining access to the throat is very difficult or nearly impossible. Although it is very unlikely, but bleeding in the throat following MMA/UPPP and unable to gain access to control the bleeding can result in the ultimate complication.

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