The Vancouver Sleep and Breathing Centre

 

HARMFUL EFFECTS

 

Laser - assisted uvuloplasty (LAUP) has been touted as a cure for primary snoring and for mild forms of Obstructive Sleep Apnea (OSA). Its purported advantages are that it is an office procedure that is associated with little postoperative pain and which has few long-term complications. However, the scientific evidence does not support these claims. In fact, comparison of the LAUP with conventional uvulopalatopharyngoplasty (UPPP) shows that:

    1. There is no difference in postoperative pain. (Journal of Otolaryngology 1997; 26:233 - 235)
    2. Results in terms of control of snoring and OSA are inferior. (Archives of Otolaryngology and Head and Neck Surgery 1997; 123:265 - 276)

In addition, the LAUP may cause OSA in a patient who only had primary snoring preoperatively and it may make existing OSA worse. (Am J Resp Crit Care Med 1997; 155(4):A939)

The following are examples of how a LAUP can adversely affect the patient's airway.

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Figure 1 - Removal of the uvula and a portion of the adjoining soft palate allows the base of the tongue to more easily occlude the airway.

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Figure 2 - Postoperative scarring resulting in narrowing of the velopharynx and oropharynx

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Figure 3 - As in Figure 2 but with increased tension in the remaining soft palate due to partial resection of the palatopharyngeus muscles

Tens of thousands of LAUPs have been performed in North America without benefit of:

    1. Appropriate preoperative testing to determine if the patient only snores or has OSA (none of the patients shown above had any testing for OSA prior to surgery).
    2. Appropriate long term follow - up to determine the outcome of the surgery.

This surgery is experimental and should not be performed outside of a strict clinical protocol. Without proper safeguards, the LAUP may well become the largest single iatrogenic cause of OSA.

 

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