What is a Uvulopalatopharyngoplasty (UPPP)?

Because the tissues of the soft palate are soft, “floppy” and sometimes enlarged, they can flutter when we breathe at night causing snoring and even blocking the breathing passages.  If the obstruction is severe enough, sleep apnea occurs.  Sleep apnea means that the person stops breathing some of the time or the oxygen in the blood drops down lower than normal or both.  UPPP is a procedure to reduce the size of the tissues of the soft palate so that they no longer block the breathing passage.  In this procedure, the uvula (the soft dangling structure you see hanging from the roof of your mouth) and the soft palate (the soft parts just above and to the sides of the uvula) are trimmed so they can no longer block the airway and make noise while sleeping.
Trimmed Uvula and Soft Palete with stitches shown.

What is a Genioglossus Advancement (GGA) Procedure?

The tongue can also get in the way of the breathing passages, especially if someone is overweight and/or out of shape.  Weight gain can mean the tongue enlarges just as other body parts do.  Also, when we are asleep, muscles get very relaxed, so the tongue, being a very large muscle, can relax back into the throat and block normal breathing.  This can cause sleep apnea as well.  The GGA procedure creates “sling” within the body of the tongue in order to bring it forward and help prevent it from falling into the back of the throat when sleeping.  In this procedure, a tiny titanium screw is placed in the chin bone, in the floor of the mouth, where it cannot be seen or felt and a special material called Prolene, which is rather like fishing line, is used to make a sling going from the screw, at an angle, to near the back of the tongue (where it cannot be felt or seen) through to the other side of the tongue, then back to the screw (see below).  The tongue is then brought forward about 1 cm.  This helps open up the airway.  The tongue is not pulled out of the mouth, but is moved into a more normal position.
1 = tongue   2 = chin   3 = titanium screw   4 = prolene material

What will happen the day of the surgery?

You will arrive at the hospital and the staff will help get you ready for the surgery.  After the surgery is over, you will be taken to the recovery room for about an hour, until you are awake from the anesthesia.  Then you will be taken to your room.  Usually you will be discharged the next day if you are drinking all right and doing well.

How will I feel after the surgery?

The number of procedures that you have done at once will contribute to how uncomfortable you are.  If you have a UPPP, a GGA and a tonsillectomy, you will be more uncomfortable than if just one procedure is done.  However, everyone responds differently.  Some people are much more comfortable than others.  Discomfort can be minimized by closely following your post-op instructions.  Expect to have swelling in the floor of the mouth and tongue if you have a GGA.

How do I take care of myself after the surgery?

• Take your pain medication regularly.  Do not wait for the pain to become worse. 
• If given Decadron, a strong anti-inflammatory, take it with food, exactly as prescribed.  This will reduce swelling.
• Keep the head of your bed elevated and do not lie flat.
• A soft diet is required for 4-6 weeks after a UPPP.  This is important to keep the stitches in place as long as necessary.
• If you had a GGA, use you tongue as normally as possible. Exercise it by frequently sticking it out in all directions.   
• Drink plenty of cool fluids and eat ice cream, popsicles and other cold and cool food and drink to reduce swelling and increase comfort. 
• Take a multivitamin and mineral supplement everyday and supplement your diet with liquid drinks such as Boost or Ensure, especially if you are not eating else.
• Call the office immediately if you have fever >101o or chills, severe pain (or worsening pain after starting to feel better), severe earache, frequent swallowing or vomiting blood or bright red bleeding for more than a couple of minutes.  Always call if you have other questions or concerns.
• No aerobics or other strenuous activity for the first 3 weeks.
• You can expect to be out of work for 2-4 weeks depending on the extent of surgery and what kind of work you do.

Post-Op Instructions for Days 1-14

Day of surgery

• Drink cool, clear liquids such as water, Kool-Aid, Gatorade, flat ginger ale or other soda, sherbert, ice cream, Popsicles, apple/grape juice
• Limit activity to getting out of bed (with assistance!) to use the bathroom.
• Take your pain medication regularly.

First day home

• Take pain medication when you first wake up.
• Drink cool liquids and eat VERY soft food such custard, pudding, applesauce, Jello, skim or 1% milk, broth, Popsicles, yogurt, ice cream, Carnation Instant Breakfast, Slim Fast, Ensure, Boost, Sustacal, etc.
• Drink ½ to 1 quart of liquids per day to prevent dehydration….this is very important!
• Stay in bed or on the couch and limit your activity.

Second day

• Continue to take your pain medication regularly.  You can try plain Typlenol.
• For breakfast, you may eat eggs (no bacon or sausage), cooked cereal such as Cream of Wheat, oatmeal, SOFT French toast or pancakes.  Lunch or Dinner suggestions can consist of soups, peanut butter and jelly sandwiches on soft bread, cheese sandwiches warmed in microwave (not grilled or toasted).
• Rest in bed or the couch most of the day.

Third day

• Continue to medicate for pain as needed, but try to decrease the amount of prescription pain medication you use during the day.
• Continued frequent use of narcotic pain medication can lead to constipation.  If this should occur, drink a glass of prune juice before bed.
• You may now add mashed potatoes, soft vegetables (no corn), pasta such as macaroni and cheese, buttered noodles or Sphaghettios.
• Be up and about the house, but do not leave home.
• Continue to limit your activities.

Fourth, Fifth and Sixth days

• Continue to use pain medication, either plain Tylenol or prescription pain reliever.
• You may add hamburger, fish and chicken to your diet.  Eggs are also an excellent source of protein.
• If you had a UPPP, expect to develop ear discomfort at this time because scabs are coming off.
• This is a sign you should rest, drink extra fluids and use your pain medication as needed.

Seventh to Fourteenth day

• Continue the soft diet.
• Return to work per the Doctor’s orders.

Form 116 Rev 11/05