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Laser-Assisted Uvulopalatoplasty for Snoring
Medium- to Long-term Subjective and Objective Analysis
Gilead Berger, MD;
Yehuda Finkelstein, MD;
Gideon Stein, MD;
Dov Ophir, MD
Arch Otolaryngol Head Neck Surg. 2001;127:412-417.
Objective To assess the subjective and objective medium- to long-term results
of laser-assisted uvulopalatoplasty for snoring.
Design A nonrandomized, prospective, before-after trial.
Subjects and Interventions Fourteen patients underwent laser-assisted uvulopalatoplasty surgery;
2 surgical techniques, which differ with respect to the mode of midline palatal
vaporization, were used.
Main Outcome Measures Subjective analysis included a preoperative and 2 postoperative evaluations
of the state of snoring: 4 weeks and 10.1 ± 7.9 months (mean ±
SD) after completion of last laser treatment. In addition, a score on 5 other
sleep-related symptoms was recorded before treatment and after 10.1 ±
7.9 months; at that time, patients also estimated their overall satisfaction
with the procedure. Objective analysis included preoperative nocturnal polysomnographic
studies that were repeated postoperatively.
Results A decline in snoring improvement from 79% (11/14) to 57% (8/14) was
recorded; furthermore, state of snoring worsened from 7% (1/14) to 21% (3/14).
Likewise, reevaluation of the 5 other sleep-related symptoms at the final
follow-up visit uncovered a 57% improvement rate. Overall satisfaction with
the procedure was 43%. The results of the postoperative objective studies
corresponded to those of the subjective ones and demonstrated significant
worsening of respiratory disturbance index in 3 (21%) of the 14 patients,
who became mildly apneic. These findings were encountered with both laser
techniques.
Conclusions The favorable subjective short-term results of laser-assisted uvulopalatoplasty
deteriorated with time. In addition, postoperative nocturnal polysomnography
showed that the procedure caused mild obstructive sleep apnea in a considerable
number of patients who formerly were nonapneic snorers. These findings may
be related to velopharyngeal narrowing and progressive palatal fibrosis, caused
by the thermal damage inflicted by the laser beam.
From the Department of Otolaryngology–Head and Neck Surgery (Drs
Berger, Stein, and Ophir) and the Palate Surgery Unit (Dr Finkelstein), Meir
General Hospital, Sapir Medical Center, Kfar Saba, Israel; and the Sackler
School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Drs Berger, Finkelstein,
Stein, and Ophir).
Corresponding author and reprints: Gilead Berger, MD, Department
of Otolaryngology–Head and Neck Surgery, Meir General Hospital, Sapir
Medical Center, Kfar Saba 44281, Israel (e-mail: berger-g{at}zahav.net.il).
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