Soft Palate Surgery Treatment for Sleep Apnea

Multiple Procedures Including Uvulopalatopharyngoplasty (UPPP) Are Helpful

Soft palate surgery like UPPP may be considered for treatment of obstructive sleep apnea
Soft palate surgery like UPPP may be considered for treatment of obstructive sleep apnea. Getty Images

If you've been diagnosed with obstructive sleep apnea (OSA), you may be interested in learning about surgical options to treat the condition. There are a number of surgeries that can change the anatomy of the soft palate and improve sleep apnea and snoring, the most common being uvulopalatopharyngoplasty (UPPP). But what other treatment options are available? Learn about the various procedures collectively known as pharyngoplasty, and the risks related to these palate procedures.

What Are the Soft Palate Procedures?

Palate surgery includes a group of procedures that is typically performed under general anesthesia in the operating room. The various soft palate procedures include the following surgeries:

  • Uvulopalatopharyngoplasty (UPPP) or palatopharyngoplasty
  • Expansion sphincter pharyngoplasty
  • Lateral pharyngoplasty
  • Uvulopalatal flap
  • Palatal advancement pharyngoplasty
  • Z-palatoplasty
  • Relocation pharyngoplasty

Palate surgery is combined with tonsillectomy in most patients who have tonsils that have not previously been removed. Palate surgery (with or without tonsillectomy) is principally used to treat obstructive sleep apnea, and the procedures can be performed alone or in combination with hypopharyngeal procedures. These procedures involve a combination of tissue removal and tissue repositioning that aims to increase the size of the airway without affecting normal functions such as breathing, speaking, and swallowing.

Specific features of the individual procedures include the following:

  • UPPP was first described for treatment of obstructive sleep apnea in 1982, and for many years was the sole procedure available. The procedure includes removal of the uvula and a portion of the soft palate, with repositioning of the remaining portion of the soft palate and sides of the throat done mainly by sewing structures together directly. Compared to other procedures, UPPP typically involves more tissue removal from the soft palate. If the uvula is not removed, this procedure is called palatopharyngoplasty.

  • Expansion sphincter pharyngoplasty involves almost no tissue removal, but more tissue repositioning. In this procedure, the muscle that is directly behind the tonsil (palatopharyngeus muscle) is freed up from the side of the throat and anchored forward and laterally. This pulls the soft palate forward, with the goal of opening the area behind the soft palate for breathing. In a selected group of patients, this procedure showed better results than UPPP in a randomized trial comparing the two.
  • Lateral pharyngoplasty can only be performed when patients have tonsils. It involves some tissue removal, but also more extensive repositioning of soft palate tissue (roof of the mouth) as well as the lateral pharyngeal tissues (side of the throat). This procedure is more-involved than UPPP, but it's also shown better results among a selected group of patients in a randomized trial comparing the two.
  • Uvulopalatal flap is used in patients with thin soft palates. The procedure involves almost no removal of muscle of the soft palate; instead, the lining of the mouth (mucosa) over a portion of the soft palate is removed to allow a folding of the soft palate muscle. Effectively, it makes the soft palate shorter without removing muscle, because muscle removal would be expected to affect normal swallowing.
  • Palatal advancement pharyngoplasty treats the palate by removing some of the bone on the roof of the mouth (hard palate) in the area towards the back, where it meets the soft palate. After removal of the bone, the soft palate is then pulled forward and sewn into place.
  • Z-palatoplasty requires partially dividing the soft palate in the middle and pulling each half forward and laterally. This can be most effective for patients with scarring on the sides of the throat, which can occur after tonsillectomy or previous other soft palate procedures. Z-palatoplasty is associated with more difficulty with swallowing following surgery than other palate procedures.
  • Relocation pharyngoplasty incorporates very little tissue removal with sewing together the muscles on the side of the throat in a specific way.

The individual surgical procedure that is most appropriate for you will require a careful physical evaluation by, and discussion with, your surgeon.

Risks of Palate Procedures Include Bleeding, Pain

As with any surgical procedure, there are risks that should be considered. Pain commonly occurs as part of soft palate surgery. Some of the other most common complications include the following:

  • Bleeding

    All surgery carries a risk of bleeding, but most of this risk is associated with tonsillectomy. A general estimate of bleeding risk after tonsillectomy is 2 to 4 percent.

  • Infection

    Infection is possible but unlikely.

  • Difficulty swallowing

    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 often happens in the first 2 weeks after the procedure, but this complication is typically not permanent or significant.

  • Changes in speech

    The palate is important for speech production. Although subtle changes in speech (identified through detailed sound analysis) can occur, major long-term changes in speech are very uncommon.

  • Narrowing at the top of the throat

    It is possible that unfavorable healing can create scarring that narrows the space behind the soft palate.

If you are interested in discussing the surgical options to treat sleep apnea, you should start by speaking with your sleep specialist. If soft palate surgery is an option based on your condition, a referral to a sleep surgeon may be the first step to explore the surgical treatment that is most appropriate for you.


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