[Carbon dioxide laser uvulopalatopharyngoplasty (UPPP). Part I. Surgical technique]

Snoring should not be regarded merely as a socially disruptive nuisance, but also as a potential risk factor of increased morbidity and mortality. Since numerous therapeutic approaches have been developed to treat snoring, the physician is faced with the dilemma of deciding which of the many possible treatments is the best for each snorer. Snoring is a sign of partial occlusion at the oropharyngeal level. Increased nasal airway resistance (NAR) may induce pharyngeal inspiratory collapse. Surgical treatment should be directed towards hindering pharyngeal collapse by surgical resection of redundant oropharyngeal tissue and/or surgical normalization of nasal resistance. Eighty-three consecutive patients suffering from snoring as major complaint together with nasal stuffiness were included in the study. Patients with OSA were excluded from the study. Increased nasal airway resistance (NAR) was a common finding in our population. Nasal surgery, involving both the external pyramid and nasal cavity, aimed at normalizing NAR was performed in 63 patients. In 15 cases, UPPP was performed contemporaneously or as a second surgical step. In 5 patients with no nasal abnormalities, pharyngeal surgery was the only surgical procedure. Personal variation of the classic UPPP is illustrated step by step in Part I. The procedure is carried out using the carbon dioxide laser, which offers several advantages both to surgeon and patient. The modified technique, which is associated with minimal morbidity, appears easy to standardize and successful in treating snoring. Results of the surgical procedures (nasal surgery and/or carbon dioxide laser UPPP) performed to treat snoring are reported in Part II.