HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Yaremchuk

palate. Appropriate laser precautions (protective eye wear, smoke evacuator) were used. The laser was set at 15 to 20 W, and a handpiece with a backstop designed to protect the posterior pharyngeal wall was used to make a vertical incision 1.0 to 1.5 cm on each side of the uvula through the soft palate. This procedure was followed by partial vaporization of the free edge of the uvula and possibly the lateral aspects of the soft palate to shorten the length. Hemostasis could be controlled with silver nitrate or other topical agents. Patients were sent home with pain medications and possibly antibiotics. LAUPs were some- times staged so that if residual symptoms were present, then a subsequent procedure could be performed. A concern was that with healing and contracture of the burned tissue, velopharyngeal insufficiency could occur. Walker 13 and Mickelson 14 reported surgical success as defined as a decrease of 50% AHI in 47.4% and 53.8% of patients with retro-palatal obstruction treated with LAUP. Finkelstein and colleagues 15 evaluated 174 patients with heavy snoring or obstruc- tive sleep apnea and compared UPPP with LAUP. The first 100 consecutive patients underwent conventional UPPP, and the subsequent 74 had LAUP performed. Sleep parameters were not measured before or after the procedure; however, anatomic measurements noted circumferential scarring in the LAUP patients, resulting in medial Fig. 3. ( A ) Local anesthetic with vasoconstrictive agent is injected in the shaded area after application of topic anesthetic. ( B ) In the case of excessive tonsillar pillar webbing or a long soft palate, additional advancement of the tissue can be obtained by placement of re- laxing incisions that extend superiorly. ( C ) Mucosal incisions are performed with lateral extension. The distal uvula may require shortening. ( D ) The mucosa is undermined and removed with sharp dissection and cautery used for hemostasis. ( E ) Closure being at the cen- tral aspect of the flap with a mattress suture. ( F ) Interrupted sutures complete the closure. ( From Huntley T. The uvulopalatal flap. Operat Tech Otolaryngol Head Neck Surg 2000;11(1):31–3; with permission.)

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