UVULOPALATOPLASTY (CAUTERY-ASSISTED)

Cautery-assisted surgery of the soft palate is used to treat simple snoring or some cases of obstructive sleep apnea. This procedure is performed under local anesthesia without sedation in the office. Every uvuopalatoplasty is different, but the procedure involves a combination of tissue removal and tightening. The procedure aims to increase the size of the airway without compromising normal functions such as breathing, speaking, and swallowing. There are multiple techniques, and the choice among them is based on the unique characteristics of each patient.

For more information about the selection of palate procedures, please see Dr. Kezirian's blog entry about choosing the best palate surgery for snoring and sleep apnea.

anatomical image of palate and tonsils before uvulopalatoplasty surgery for snoring or sleep apnea

RISKS

Bleeding
Uvulopalatoplasty carries a small risk of bleeding. A major factor in preventing serious bleeding is to avoid the use of aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks before and after surgery. If bleeding occurs, patients should notify their doctor immediately. Another procedure—either performed in the outpatient clinic or the operating room—may be necessary to control the bleeding. Please notify your surgeon immediately if you have bleeding of a teaspoon or more. If the bleeding is significant, immediately seek care in the closest emergency department or call 911.

Infection
Infection is rare but not impossible after uvulopalatoplasty. Patients typically receive antibiotics at the time of surgery to reduce the chance of infection and decrease swelling. Patients should not use mouthwashes following surgery because many of these contain alcohol that can irritate the lining of the mouth and interfere with healing.

Regurgitation
The palate is important in swallowing because it seals the connection between the back of the mouth and the back of the nose. After palate surgery, it is possible to have foods, especially liquids, come up in the back of the nose or occasionally through the nose. This happens in many patients for a brief period (1-2 days) due to swelling in the area, but it is unusual for this complication to be permanent.

Changes in speech
Any operation on the palate can cause changes in speech, but these changes are rarely permanent.

Throat dryness or feeling of something stuck in the throat
Any operation on the palate can affect the throat in unpredictable ways, and it is possible for some patients to dryness or a feeling that something is stuck in the throat. These are usually temporary, but they can be permanent.

Narrowing at the top of the throat
Rarely, palate surgery will result in narrowing behind the palate—which is also the top of the throat. This complication can make breathing through the nose difficult as well as create problems with speaking and swallowing. Additional surgery may be necessary to correct this problem.

Continued snoring
Most patients undergoing palate surgery will have loud snoring. The goal of the uvulopalatoplasty procedure is to reduce snoring and eliminate obstructive sleep apnea (if it is present). Usually snoring will improve dramatically. However, many patients will continue to snore to some extent, even after successful surgery.


POSTOPERATIVE INSTRUCTIONS

NOTIFY DR. KEZIRIAN IMMEDIATELY IF YOU HAVE ANY TROUBLE BREATHING OR IF ANY BLEEDING DEVELOPS!

Pain control
You should be prescribed narcotic pain medication after the uvulopalatoplasty procedure. Take this medication as you need it for pain control, and try not to let the pain increase until it becomes intolerable before you take the medication. If you are running out of medication and need more, please call the office in advance to obtain another prescription. If you prefer to avoid narcotics, you should feel free to use acetaminophen (Tylenol®). Avoid aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks because they can increase your risk of bleeding after surgery. Your pain will be significant for at least the first 5-7 days following surgery, but it should improve markedly by 10 days following surgery.

Nutrition and fluids
It is very important to have good nutrition and avoid dehydration after surgery. Due to the pain and swelling that is expected after surgery, you will most likely only be able to tolerate a liquid diet for the first 4-5 days after surgery. Push yourself to drink fluids, even if it is painful. The first sign of dehydration is a decrease in urination, so keep track of this. In addition to water, it is It is helpful to drink other liquids, such as juices or Gatorade®. It is also essential that your body receive protein and fat in your diet to help with healing and maintaining your energy level. Every day, you should have 3 glasses of something with fat and protein like milk or chocolate milk, nutritional supplements like Muscle Milk® or Ensure®, or protein shakes. Dr. Kezirian may order a nutritional supplement like this while you are in the hospital. As your recovery continues, you will transition to soft solid foods such as eggs, yogurt, or mashed potatoes. You should be able to tolerate a fairly normal diet by 2 weeks after surgery. During the recovery period, you should avoid foods with sharp edges such as chips because these can cause bleeding. Otherwise, you can advance your diet according to your own schedule, being careful not to cause too much pain. Dr. Kezirian wants his patients to maintain their nutrition so that they do not lose weight in the few weeks right after surgery.

Antibiotics
You may be prescribed an antibiotic. This can be useful for preventing infection and decreasing swelling. Take the antibiotics as directed. If you develop a rash or diarrhea (possible risks of antibiotics and other medications), stop the antibiotics and contact your doctor immediately.

Minimize physical activity for 3 weeks
At a minimum, patients should walk at least 3 times a day starting the day after surgery. Walking and spending more time out of bed (walking or in a chair) rather than in bed are helpful because they reduce the risks of developing pneumonia or blood clots in the legs. However, patients should avoid strenuous activity for 3 weeks because it typically raises heart rate and blood pressure. For this reason, it can increase swelling or cause bleeding to start.

Do not use mouthwashes, lozenges, or throat sprays
Patients should not use mouthwashes, lozenges, or throat sprays following surgery because many of these contain alcohol that can irritate the lining of the mouth or numbing medication that can expose you to a serious complication when used for more than a couple of times.

Ear problems or jaw discomfort
The swelling in your throat that occurs after surgery can cause jaw pain or ear symptoms such as pain, pressure, or fullness. This is common and should improve within 1-2 weeks following surgery. It occurs because the soft palate and tonsils are next to the jaw and the small Eustachian tube that connects the space behind the eardrum to the top of the throat. Swelling in the throat can interfere with your ability to clear or pop your ears, and it can also be sensed by your body as pain coming from your ears even though the ears are not affected (a phenomenon called referred pain).

Sleep with head elevated (at 45 degrees) for at least three days
Elevating your head during sleep decreases blood flow to the head and neck regions. Therefore, it decreases swelling and the associated pain. Elevating the head during sleep may also improve breathing patterns in other ways. Therefore, we recommend elevating your head during sleep at 45 degrees for at least three days following the procedure.

Additional questions
Please call the Nurse line at 323-442-0190 with any questions during normal business hours. For after hours or weekends, please call the Call Center at 323-442-5790 to speak to the physician on call.