Abstract
Objectives: Uvulopalatopharyngoplasty (UPPP) is the preferred surgical technique used to treat obstructive sleep apnea. UPPP includes uvula excision, estimated by any one of a number of methods, such as palpation of the posterior wall through the soft palate to determine the level at which it no longer makes contact, or by transecting the soft palate at some predetermined site regardless of the palatal arch's characteristics or its proximity to the posterior wall. One consequence of removing too much tissue is velopharyngeal insufficiency; excising too little tissue causes residual obstruction.
Methods: Transection of the muscularis uvulae disrupts the contiguous fibers of the tensor veli palatini and the levator veli palatini, alters soft palate tension, elevation, and drawback, and affects eustachian tube dilation, potentially disrupting function from the oropharynx to the middle ear space.
Results: To minimize morbidity caused by uvulectomy, we remove a greater proportion of tissue in the lateral aspect of the faucial arch, plicate the postero-lateral soft-tissue laterally, and create through-and-through parauvular fissures, which appears to elongate the uvula. To correct this distortion we perform a partial uvulectomy. The uvula is retracted inferiorly and trimmed at a 30° angle using several sweeping motions on each side with a needle-tip cautery set at 15 to 20 watts. An “arrowhead” tip is created. If too much uvula remains, the same steps are repeated until the desired length is achieved.
Conclusion: Due to its dependent position, the tip assumes a rounded contour as it heals. With the soft palate aponeurosis preserved, the foreshortened uvula retains its primary functions.