What is snoring-VI

Laser assisted uvulopalatoplasty (LAUP)

Laser assisted uvulopalatoplasty (LAUP) is an older procedure which involves trimming the palate with a laser. It can be performed in the doctor’s office under local anesthesia. Small cuts are made in the palate on each side of the uvula with a laser. Several procedures are usually needed for a maximal effect. The scarring caused by the procedure stiffens the palate, decreasing the ability of the palate to vibrate and pulls the palate sideways to tighten it. This procedure results in moderate pain for one to two weeks that is generally controlled with oral pain medications.

Other methods to stiffen the palate in the office include injections with a sclerosing agent, radiofrequency ablation of the palate, cold ablation of the palate, or in-office palatoplasty procedures.

Snoring due to a long, floppy palate can be treated with office procedures that stiffen the palate. Like a sail on a sailboat, the air moving around the palate can cause vibrations of the tissue. For a sailboat sail, battens are placed to stiffen the sail and decrease vibration. Similarly, a stiffer palate vibrates less. The palate can be stiffened by creating scar tissue (as discussed previously) or with implants.

Radio-frequency ablation of the palate

Radio-frequency ablation of the palate can be performed under local anesthesia in the doctor’s office. Usually, three tunnels in the tissue are made with a radiofrequency wand. The radiofrequency energy is applied for approximately ten seconds with the wand in the palate muscle tissue. The tissue heals as scar tissue, and the palate becomes stiffer and vibrates less. Generally, scar tissue in the palate continues to form for up to three months. Up to 77% of people report reduced snoring after this procedure, however, as the tissue continues to heal over time, the palate may soften and re-obstruct. One study demonstrated a 29% relapse in snoring after one year.

Palate implants

Palate implants are now being used to treat snoring. They are made from Dacron, which is a non-reactive material that has been used for many years for heart valve surgery and hernia repair. Dacron also encourages the normal tissue to grow into it. Small Dacron implants are placed into the palate under local anesthesia. The implants stiffen the palate just like scar tissue does after radiofrequency treatments. The implants stay in the tissue, so recurrence of snoring should be reduced.

Correct patient selection is important. The placement of the implants is done near the posterior edge of the hard palate. If the patient has a long, floppy, soft palate and uvula, there may be a lower likelihood of successful reduction in snoring. Multiple implants can be placed, with additional implants added up to a total of 5 in some cases. Some relapse after 12 months was common in many studies, and no significant reduction in obstructive sleep apnea has been shown with any consistency.

There is a small increased risk of infection after insertion of foreign material in the palate tissue. If this occurs, the implant should be removed and replaced with another implant. Although this sounds like a negative consequence, infection actually leads to scarring, which helps decrease the vibrations of the palate. The implant procedure results in less tissue inflammation and therefore the procedure does not hurt as much or for as long as following radio-frequency treatments.

What is the success of surgery for snoring?

Surgeries are generally successful in reducing snoring. The success of a procedure depends on the problem area causing the snoring. For example, someone with nasal congestion will not have much improvement with a palate procedure and vice versa. The other factor that makes success hard to measure is the definition of success. As discussed earlier, the goal of surgery should include a successful night’s sleep for those around the snorer.

Palate implant surgery has been reported to decrease snoring. On a loudness scale of 1 to 100, the average decrease is from 79 to 48 at three months. Is a snoring level of 48 a success? For some people it may be, but for others it may not. Similarly, palate implant surgery was recommended by 89% of snorers, but only 69% of their partners. Palatal implant surgery, like other surgeries, is very successful if the patients are carefully selected. Only people with snoring due to palate problems will improve with palate surgery, and only the snorer’s partner will determine if the improvement in snoring is a “success.”

— medicinenet.com

 

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