1. DIATHERMY ASSISTED UVULO-PALATOPLASTY (DAUP) Prof. Hamad Al Muhaimeed and Dr. Saad Al Garni Department of ORL King Abdul Aziz University Hospital Riyadh, Saudi Arabia

2. Diathermy assisted Uvulo-Palatoplasty Snoring - common problem - socio-medical manifest 25%M, 15%F - snore habitually (Laryngo July, 1997) If severe enough - sep. sleeping arrange Non-surgical Rx - minimally successful

3. Diathermy assisted Uvulo-Palatoplasty The pathophysiology - vibrations uvula, soft palate, T. pillars Therefore surgical Rx - these anatomical areas Ikematsu, 1952 - the first surgical Rx Fujita, et al 1981 - UPPP The standard Rx - until recently

4. Diathermy assisted Uvulo-Palatoplasty Complications of UPPP includes: – Intubation diff. - (full neck, large tounge) – Hemorrhage - 2% – Postoperative N. regurg. - 20-60% – VPI - 0.5% – Overnight hospitalization

5. Diathermy assisted Uvulo-Palatoplasty Electrocautery - out pt. DAUP (CAUP) This altern. to laser: - more economical - doesn't require training - or safety precautions Done under LA, no sedation Quick, easy to perform (5)

6. Diathermy assisted Uvulo-Palatoplasty 2 full-thickness vertical incisions - free edge of s. palate Approximately 1-1.5 cm - both sides of uvula Uvula is reshaped - length 60-90% Mucosal incisions - first dotting the mucosa Then connecting the lines - incisions (more deeply) (6)

7. Diathermy assisted Uvulo-Palatoplasty Avoid - collateral burn injury (direct or indirect) Also care - not to cauterize post Ph. wall - or cut into the palatal musc. The uvula - much longer After the lateral troughs are cut (7)

8. Diathermy assisted Uvulo-Palatoplasty (8) No.Age/SexComplaintOn ExamF. UpOutcome 152 / MSnoringRedundant soft palateSnoringSnoring > 70% improv. TonsilitisMild DNSno pain, no VPINo pain after No N. regurg. 260 / MSnoringRedundant soft palateSnoringSnoring. 70% improv. Elongated uvulaNo pain, no VPINo pain after 2/52 Mild DNSNo N. Regurg. 340 / MNarcolepsyRedundant soft palateSnoringSnoring > 70% improve. SnoringNo pain, no VPINo pain after 2/52 No N. regurg. 459 / M*SnoringRedundant soft palateNo snoringSnoring > 70% improv. Sleep apneaNo pain, no VPINo pain after 2/52 No N. regurg. *Two stages

9. Diathermy assisted Uvulo-Palatoplasty Table 1. Demographic data by group *Numbers in parenthesis are ranges CAUP = Cautery-assisted uvulopalatoplasty LAUP = Laser-assisted uvulopalatoplasty CAUP (n=51)LAUP (n=47) Men (n)4843 Women (n)34 Age (y)40 (25-50)42.9 (23-75)* (9)

10. Diathermy assisted Uvulo-Palatoplasty Table 2. Duration of pain by group after each procedure (10) MeanRange SDMeanRangeSD Pain peaked on day no.3.530.81.593.320.102.287 Resolution of pain11.030.244.26610.020.214.262 on day no. CAUP LAUP

11. Diathermy assisted Uvulo-Palatoplasty Table 3. Severity of pain by group after each procedure (11) Mild Moderate/SevereSevere Group Nonen % CAUP 023 2464 687 8 LAUP 026 2753 5814 15 Severity of pain

12. Diathermy assisted Uvulo-Palatoplasty Mean = 0.75; range 0.6; SD 1.066 Mean = 0.78; A9 0.6; SD 0.982 Days (n)CAUP (n=51)LAUP (n=47) 03031 1138 251 315 622 Table 4. Total number of workdays per patient for all treatments by group (12)

13. Diathermy assisted Uvulo-Palatoplasty (13) CAUP (n=51) n % LAUP (n=47) n % Cured (>70% reduction)26 5123 49 Improved (30%-70% reduction)23 4521 45 Unchanged (<30% reduction)2 43 6 Table 5. Effectiveness of reduction of snoring group

14. Diathermy assisted Uvulo-Palatoplasty (14) Procedure CAUP (n=51) n % LAUP (n=47) n % 126 5121 45 213 2514 30 38 168 17 42 4 5 600 Table 6. Number of procedure required by group

15. Diathermy assisted Uvulo-Palatoplasty (15) CAUP (n=51) n % LAUP (n=47) n % Temporary VPI*2 41 2 Infection1 2 Bleeding requiring Ag NO1 2 Nasopharyngeal stenosis00 Permanent VPI00 Table 7. Number of procedure required by group VPI = velopharyngeal insufficiency

16. Diathermy assisted Uvulo-Palatoplasty Conclusions: Snoring - Extensive changes - Several surgical procedures DAUP - out-patient setting, LA no sedation Safe, effective - reducing both, snoring Results - equivalent to LAUP (16)