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Anatomical Considerations

Yehuda Finkelstein, MD; Myra Shapiro-Feinberg, MD; Gideon Stein, MD; Dov Ophir, MD

Arch Otolaryngol Head Neck Surg. 1997;123(3):265-276.

Abstract
Objective
To assess and compare anatomical changes in the velopharynx produced by conventional uvulopalatopharyngoplasty and by laser-assisted uvulopalatoplasty.

Design
A before-after trial of patients who underwent conventional or laser-assisted palatal surgical procedures.

Patients and Interventions
A total of 174 patients (157 men and 17 women; age range, 22-71 years; mean age, 48 years) who were suffering from heavy snoring (n=16) or obstructive sleep apnea. The first 100 consecutive patients underwent conventional uvulopalatopharyngoplasty, and the remaining 74 underwent 1 of 2 surgical variations of laser-assisted uvulopalatoplasty.

Main Outcome Measures
Preoperative and postoperative examinations included peroral photographs of the oropharynx and nasopharyngoscopic examination of the velopharyngeal valve. In 10 randomly selected patients, postoperative lateral and frontal cephalometric radiographs, enhanced with contrast media, were compared with routine preoperative radiographs.

Results
Uvulopalatopharyngoplasty results in an enlargement of the oropharynx and an increased velopharyngeal air space. Laser-assisted uvulopalatoplasty, by producing a raw surface, involves circumferential scarring, the severity of which depends on the velopharyngeal axial configuration; therefore, it can result in a diminished velopharyngeal air space and decreased distensibility.

Conclusions
From an anatomical viewpoint, laser-assisted surgery of the palate is significantly inferior to conventional uvulopalatopharyngoplasty and may even be deleterious. The results of preoperative and postoperative polysomnographic comparisons in patients who undergo laser-assisted operations should be evaluated to determine whether future laser-assisted surgery is an adequate option, even for snoring as an isolated symptom.

Arch Otolaryngol Head Neck Surg. 1997;123:265-276

Author Affiliations
From the Departments of Otolaryngology—Head and Neck Surgery (Drs Finkelstein, Stein, and Ophir) and Radiology (Dr Shapiro-Feinberg), Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Finkelstein, Shapiro-Feinberg, Stein, and Ophir).

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