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UP3 - UvulopalatopharyngoplastyThe tonsils play an important role as a defense system against infections in the upper respiratory tract during childhood. The tonsils are lymphoid tissues located in the back and on each side of the throat. The adenoid tonsil is also made up of lymphoid tissue and is located in the upper back part of the throat behind the nose. They work together to “catch” and trap incoming infections. Unfortunately, the tonsil and adenoid may become the source of infection itself like a plugged filter or block the upper airway. Tonsillectomy is recommended for adults with signs and symptoms of:
Numerous medical studies have definitively proven that removal of the tonsils is helpful for the above problems without resulting Sleep apnea surgery may be performed simultaneously. Surgery most commonly involves shortening the soft palate and uvula at the same time as tonsillectomy. This procedure tightens the loose tissue in the throat to relieve the obstruction of the upper throat. This is called uvulopharyngopalatoplasty or more simply UPPP. If your obstruction includes the lower throat, your doctor may also perform a procedure called geniohyoid advancement (GHA) with thyrohyopexy (THP). The purpose of this procedure is to pull the back of the tongue forward to increase the size of the lower throat. This procedure requires additional incisions on the inside of the mouth behind the lower lip and also in the front of the upper neck. Some twenty years have elapsed since ENTs began to embrace UPPP as one of their primary surgical interventions for OSA(Obstructive Sleep Apnea). Since then, mounting research has consistently reported UPPP cure rates at 40-50%. While some patients respond favorably to UPPP alone, others clearly do not. The reason is that most patients suffer from multi-level obstruction. For instance, in one study following 416 OSA patients, 87% suffered from multi-point obstruction. Perhaps the most straightforward way to determine which patients require more than a UPPP is the Friedman staging guide for the surgical treatment of OSA. Endorsed by the American Academy of Otolaryngology, Head & Neck Surgery, the Friedman Staging System can "help stratify patients into those who are likely to benefit from UPPP alone and those who need additional treatment, usually directed at the hypopharynx and tongue base." The physician has the patient open their mouth with their tongue in their mouth. Based on how much of the soft palate, tonsils and uvula he or she can see, the following staging assignments are made. A tonsillar evaluation completes the staging assignment. In Dr. Friedman's study, he retrospectively looked at cure rates by stage for UPPP-only patients. In Friedman Stage 1 he achieved an 80.6% cure rate, Stage 2 a 37.8% cure rate and in Stage 3 an 8.1 % cure rate. See his conclusions for surgery below. Friedman Staging System
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in any long-term negative impact on the immune system. Fortunately, there is ample other lymphoid tissue still remaining in the throat to perform its immune function (i.e., lingual tonsils on the back of the tongue, accessory tonsils on the back wall of the throat, Gerlach tonsils near the Eustachian tube opening, etc).
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