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

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

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

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

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)

Diathermy assisted Uvulo-Palatoplasty 2 full-thickness vertical incisions - free edge of s. palate Approximately 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)

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)

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

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)

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

Diathermy assisted Uvulo-Palatoplasty Table 3. Severity of pain by group after each procedure (11) Mild Moderate/SevereSevere Group Nonen % CAUP LAUP Severity of pain

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

Diathermy assisted Uvulo-Palatoplasty (13) CAUP (n=51) n % LAUP (n=47) n % Cured (>70% reduction) Improved (30%-70% reduction) Unchanged (<30% reduction) Table 5. Effectiveness of reduction of snoring group

Diathermy assisted Uvulo-Palatoplasty (14) Procedure CAUP (n=51) n % LAUP (n=47) n % Table 6. Number of procedure required by group

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

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)