Has anyone ever had the UPPP surgery or the surgery where they put a screw in the tounge?
My mom is 64 and she is worried about getting through the surgery.  Any advice is appreciated?

jkquinn26 wrote:

Has anyone ever had the UPPP surgery or the surgery where they put a screw in the tounge?
My mom is 64 and she is worried about getting through the surgery.  Any advice is appreciated?

The following link is to a topic in the Interesting Links section of this forum.  This is a collection of links to discussions and articles on about three of the surgeries most asked about.  The UPPP surgical procedure is discussed towards the end of this list:

Click here for link



Linda

jkquinn26 wrote:

Has anyone ever had the UPPP surgery or the surgery where they put a screw in the tounge?
My mom is 64 and she is worried about getting through the surgery.  Any advice is appreciated?

Had the UPPP. It's barbaric and if your mother has OSA it is almost certain not to work, as regards a cure.

The other surgery is pretty much in the same category. There is a full description of all this surgery at www.isat.ie and go to the FAQ.

A 64 year old should not have to go through either of these procedures.

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Hi,
   Daniel is the UPPP domesday sayer.  He must have had an extremely bad experience.  I would certainly not seek advice from this board regarding surgery.  I have herad very little positive here.  I asked my DR. for references and spoke with some people who had the procedure and got a vestly different opinion than what is gathered here.  The procedure is very painful and I would recommend a cpap or other treatment first.  As far as a screw in the tongue, in all my research on the UPPP I never came across anything regarding that. You can read about my very recent experience in a post I made earlier.  Everyone tolerates pain differently so I wold suggest getting many different opinions.

Anthony wrote:

Hi,
   Daniel is the UPPP domesday sayer.  He must have had an extremely bad experience.  I would certainly not seek advice from this board regarding surgery.  I have herad very little positive here.  I asked my DR. for references and spoke with some people who had the procedure and got a vestly different opinion than what is gathered here.  The procedure is very painful and I would recommend a cpap or other treatment first.  As far as a screw in the tongue, in all my research on the UPPP I never came across anything regarding that. You can read about my very recent experience in a post I made earlier.  Everyone tolerates pain differently so I wold suggest getting many different opinions.

Hi Anthony,

Like myself, you are certainly entitled to an opinion on surgery for OSA, but calling me a doomsday sayer is a little harsh.

My negative attitude on surgery is based, not entirely on my own experience, but more importantly on peer reviewed studies. Below is a list of the various surgeries currently available for OSA (with the exception of the Pillar Procedure). You will note that it also covers the 'screw' surgery..........which has been around for some time now. Maybe your research was not quite as extensive as you thought.

I would also suggest that you check out The Scottish Intercollegiate Guidelines Network at www.sign.ac.uk and go to Guideline No. 73 which prints off to about 38 pages, where every procedure is covered.

If your doctor bothered to check the numerous guidelines and studies available, I doubt he would push you towards the UPPP..........but there again he is also entitled to an opinion, but it should be more informed than yours or mine.

Daniel.


Nasal Surgery
Septoplasty
The septum is the divider between the two nasal passages. A deviated (crooked) septum may obstruct the nasal airway. A Septoplasty is performed through the nostrils. The cartilage and bone of the septum is straightened.

Turbinate Reduction
The turbinates within the nose are made of bone surrounded by soft tissue whose function are to warm and moisten the air as you breath. There are three turbinates in each nostril (lowest, middle and upper). Reduction of the size of an enlarged turbinate can improve the size of the nasal airway. Turbinate reduction may be performed with surgical instruments, lasers. radio frequency energy or cauterised.

Removal of Polyps
Nasal polyps can obstruct the nasal airway. Removal of polyps can ‘free up’ the airway.

Sinus Surgery
Sinus infections can contribute to nasal obstruction and surgery may be necessary.


Upper Airway Surgery
Uvulopalatopharyngoplasty (UPPP) surgery
This surgery removes the uvula, the lower edge of the soft palate trimmed.  If present, the tonsils are generally removed and tissues around the tonsils trimmed.  It can be done separately or in conjunction with other treatments, depending on where in the airway the obstructions occur.  There are the usual surgical risks involved with this surgery.  Notable ones are general anaesthetic (depresses breathing reflex and can be risky in people with breathing problems like sleep apnoea), swelling of the airway, need for pre-and post-operative medications (may depress the breathing reflex), bleeding, and significant pain lasting up to several weeks.

Is it effective?
Will it free me from having to wear a CPAP machine for life?
This surgery seems to have a history of being about 50% effective in about 50% of patients who have it.  In other words, many of the people who have UPPP will end up having to use CPAP anyway.  It is almost never a "cure-all."  The risks and side effects of the surgery are usually not worth it.  This is a decision that each person has to make, but you should give it a great deal of thought beforehand.  Surgery is not something to be undergone on a whim, and certainly not for the sole reason of ridding yourself of the need for CPAP.  The vast majority of people who have undergone UPPP for the treatment of Obstructive Sleep Apnoea do have to continue using CPAP.

UPPP is seldom, if ever, used for treating OSAS in Ireland or England.

Laser-Assisted Uvulopalatopharyngoplasty (LAUP)
LAUP is a relatively new laser surgery on the uvula and soft palate that is reported to diminish snoring, but no controlled studies have been done to show that it reduces sleep apnoea.  Because it is less extensive than UPPP, it is unlikely to be any more effective than UPPP in treating obstructive apnoea.  It is usually done in several steps, and is an outpatient procedure.  For that reason it is less risky than UPPP.

While the procedure may sometimes be effective in helping people who snore but do not have apnoea, the main danger from LAUP is that people may eliminate their snoring and assume that their problems are solved, when in fact they may still have untreated sleep apnoea which may continue to get worse but be ignored because its primary alarm signal (snoring) has been silenced.  Potential patients should be careful that they don't see an ad in the paper, call the doctor, and rush into an LAUP procedure without research and consideration.

Somnoplasty (Radio-frequency Tissue Ablation of the Palate)
Deliverance of Radio-frequency waves by a needle electrode to the underside of the soft palate to cause contraction of excessive tissues that cause snoring.  This procedure involves a progressive shrinkage of the soft palate and uvula.  Usually patients require up to four treatment sessions of 15/20 minutes, under local anaesthesia.  The procedure is relatively painless.

Tonsillectomy and Adenoidectomy
Tonsils are tissues on the sides of the upper throat and if enlarged may narrow the width of the upper airway.  Adenoids are at the back of the nose and can obstruct the nasal airway.  This surgery is most common with children as Adenoids usually shrink with age.

 Lower Airway Surgery
Genioglossus Advancement
The Genioglossus muscle attaches from the back of the tongue to a spot on the back of the chin.  This surgery attempts to pull the back of the tongue forward in an effort to enlarge the air space behind the tongue.  The procedure pulls forward a rectangular or circular segment of chin bone (below the front four teeth) and holds it in place with a plate or screw.  A minimal change in the appearance of the chin results (millimeters).

Hyoid Advancement
The Hyoid bone is just above the Adam’s apple.  The Hyoid bone is moved forward and either attached to the Adam’s apple or jaw bone.  The purpose is to enlarge the air space behind the tongue.

Midline Glossectomy, Lingualplasty, and Lingual Tonsillectomy
Midline Glossectomy involves a reduction in the size of the tongue (if enlarged).  The back of the tongue is reduced in size by excising a V shaped portion of the centre part of the tongue.  Lingualplasty is a more aggressive resection with additional removal of side wedges.  Lingual Tonsillectomy involves the removal of
tonsil like tissue on the back part of the tongue, it may also be removed with a laser.  A temporary tracheostomy is usually performed with these procedures to avoid breathing difficulty that might result from temporary swelling. The purpose is to reduce the size of the tongue thereby increasing the air space behind the tongue.

Bimaxillary Advancement (Lafort 1 Maxillary Osteotomy with Bilateral Sagittal Split Mandibular Osteotomy)
The upper and lower jaw bones are moved forward along with all teeth in an effort to pull soft tissue structures forward and make more room for the tongue.  Metal plates and screws are used to hold the realigned jaw bones in place.  Orthodontic work prior to or following the procedure may be necessary to maintain proper alignment of the teeth.  Change in facial appearance relates to the extent of the advancement.

Tongue Suspension Suture (Repose)
The tongue is pulled forward by way of a permanent stitch attached to a screw which has been placed through the back of the tongue.  This is to prevent the tongue falling back during sleep and obstructing the airway.


Surgical Bypass of the Airway
Tracheostomy
An opening is made at the front of the neck to the windpipe and a plastic or metal pipe is inserted. During sleep the patient breathes through the tube, while during the day the tube is covered to allow normal speech and breathing. There are considerable hygiene problems with this procedure.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Anthony wrote:

Hi,
   Daniel is the UPPP domesday sayer.  He must have had an extremely bad experience.  I would certainly not seek advice from this board regarding surgery.  I have herad very little positive here.  I asked my DR. for references and spoke with some people who had the procedure and got a vestly different opinion than what is gathered here.  The procedure is very painful and I would recommend a cpap or other treatment first.  As far as a screw in the tongue, in all my research on the UPPP I never came across anything regarding that. You can read about my very recent experience in a post I made earlier.  Everyone tolerates pain differently so I wold suggest getting many different opinions.

There is a reason for being negative on it.  It has a very poor success rate.  It sounds like you want to have an easy answer like the doctors say UPPP is, but the simple fact is, that it isn't.  But you are entitled to your opinion.  But when the surgery doesn't work, I hope that you would warn others like Daniel does.  I personally know of 5 people that have had UPPP.  All are on CPAP.  so in my experience it has a 0% success rate.  Its expensive, its painful, and it doesn't work for most people.  (this isn't saying that other surgeries like turbinate, or sinus are not successful, but they are not treatments for OSA, but merely assist in CPAP working)

And again, please come back about a year after your surgery, and let us know how you are doing.