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Gilead Berger, MD; Yehuda Finkelstein, MD; Dov Ophir, MD

Arch Otolaryngol Head Neck Surg. 1999;125:786-790.

Objective  To assess late histopathologic changes of the soft palate after laser-assisted uvulopalatoplasty in patients with snoring and mild obstructive sleep apnea.

Design  A nonrandomized, histopathologic controlled study.

Subjects and Interventions  Palatal surgical specimens were removed from 10 patients with snoring and obstructive sleep apnea in whom laser-assisted uvulopalatoplasty was not successful and who subsequently underwent uvulopalatopharyngoplasty. The mean interval between the last laser treatment and uvulopalatopharyngoplasty was 24 months. The patients' specimens were compared with those of a control group consisting of 12 palates and uvulae excised during uvulopalatopharyngoplasty.

Results  After laser-assisted uvulopalatoplasty, all soft palates displayed marked and progressive pathologic changes that increased with every additional treatment and extended far beyond the point of laser beam application. The loose connective tissue present in the lamina propria was replaced by diffuse fibrosis, which also extended to the central layer, on the expanse of seromucous glands and muscle fibers. Other changes included ulceration of the oral epithelium and a patchy inflammatory reaction.

Conclusions  Extensive thermal-induced changes, involving the 3 layers of the organ, were found. They are compatible with clinical observations reported elsewhere and are probably responsible for the worsening of the obstructive sleep apnea status and the sensation of the pharyngeal dryness that developed months after the laser-assisted uvulopalatoplasty. Although it has immediate benefits, the procedure is still relatively new and all its implications are as yet unknown.

From the Department of Otolaryngology–Head and Neck Surgery (Drs Berger and Ophir) and the Palate Surgery Unit of the Department of Otolaryngology–Head and Neck Surgery (Dr Finkelstein), Meir General Hospital, Kfar Saba, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.

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