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Is there a better way to do laser-assisted uvulopalatoplasty?
Gilead Berger1, Gideon Stein, Dov Ophir
1Department of Otolaryngology-Head and Neck Surgery, Meir Hospital, Sapir Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Kfar Saba, Israel. berger-g@zahav.net.il
Objective:
To assess the subjective and objective short- and medium- to long-term results of laser-assisted uvulopalatoplasty (LAUP) for snoring and obstructive sleep apnea.
Design:
A nonrandomized, prospective, before-after trial.
Patients And Interventions:
Twenty-five patients underwent a modified procedure of LAUP termed one-stage LAUP, and a matched control group of 24 patients underwent uvulopalatopharyngoplasty.
Main Outcome Measures:
Subjective analysis of LAUP included a preoperative and 2 postoperative evaluations of the state of snoring (4 weeks and after a mean +/- SD of 12.2 +/- 9.9 months). A score on 5 other sleep-related symptoms was recorded before and after completion of LAUP. The objective polysomnographic outcomes were compared with a control group undergoing uvulopalatopharyngoplasty.
Results:
In 25 patients, improvement in the state of snoring significantly declined from 76% (n = 19) to 32% (n = 8), and worsening increased from 12% (n = 3) to 32% (n = 8) (P<.001). Evaluation of 5 other sleep-related symptoms showed that 52% of patients (n = 13) improved and 20% (n = 5) worsened. Polysomnography of LAUP patients showed that the mean postoperative respiratory disturbance index worsened significantly (33.1 +/- 23.1) compared with the preoperative one (25.3 +/- 14.3) (P =.05); also, 20% of the procedures were successful and 36% revealed marked worsening. The respiratory disturbance index of uvulopalatopharyngoplasty patients changed from 26.0 +/- 18.0 to 18.7 +/- 21.3, yet improvement did not reach statistical significance (P =.09). Furthermore, 58% (n = 14) of the surgical procedures were successful and only 8% (n = 2) revealed marked worsening.
Conclusions:
The favorable, subjective, short-term results of modified LAUP deteriorated over time. The procedure might also lead to aggravation of existing apnea. These findings are probably related to progressive palatal fibrosis and velopharyngeal narrowing originated by the laser beam.
