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Laser Assisted Uvulopalatoplasty - Technical Information

Indications:

Snoring, Mild obstructive sleep apnoea, “lump in throat”.

Heavy snoring causes many problems for all concerned. Fortunately the LAUP technique is helpful in more that 95% of cases treated by the London Laser Clinic. However, not everyone is suitable for surgery and each person is assessed on an individual basis.

The following questionnaire is important in assessing suitability for surgery. The answers in bold Italics indicate suitability for surgery, although some of the correct responses are not mandatory.

• Are you highly overweight or have a very fat neck? YES/NO NO
• Is your collar size 17.5 inches or greater? YES/NO NO
• Do you make the classical snoring sound? YES/NO YES
• Do you make a sucking snoring sound? YES/NO NO
• Is your snoring only alcohol related? YES/NO NO
• Do you stop breathing recurrently throughout the night,
  for significant periods (more than 10 seconds) ?YES/NO NO
• Do you suffer with excessive daily tiredness? YES/NO NO
• Are morning headaches a regular occurrence? YES/NO NO
• Are you asthmatic - if so which treatments do you take? YES/NO NO
• Are you diabetic - if so what medication do you take? YES/NO NO
• Do you have any major illnesses (if so, what are they?) YES/NO NO

Information Regarding the Operation

Which Laser?

Sharplan 1020, 1030 or 1040 with Swiftlase,

Diomed 15, 25, 60 with sculpted tip or bare fibre

Most LAUP operations are performed under local anaesthetic. Occasionally, however a general anaesthetic will be required.

Before the operation

If you are having a general anaesthetic, you may have to undergo certain tests e.g. blood samples, chest x-ray etc.

You will be asked to sign a consent form before surgery to take place.

During the operation

Firstly, an anaesthetic spray will be applied to the back of the mouth and left for 2 minutes. It tastes slightly bitter, but you will then be able to spit the spray out into a bowl.

Next, your tongue will be gently pushed down with a smooth wooden spatula, and to aid this stage of the procedure try to relax your mouth and throat as much as possible. You can practice this at home prior to the operation, using a spoon or something similar with which to depress your tongue.

A syringe and fine needle will then be used to deliver 3 small injections to the palate at the back of the mouth, these are hardly felt as the anaesthetic spray will have numbed the area. After 30 seconds, the whole area to be treated is entirely numb and the operation, which is completely painless, can proceed.

Again the tongue is gently depressed with a spatula. The laser operation commences, the soft palate is cut, reduced in bulk and shortened by vapourisation and coagulation. During the operation you will be asked to take deep breaths in and gently let this breath out, by saying aaaaaaah, for as long as possible.

The whole procedure usually takes around 10 minutes. It is not continuous, rather more ‘stop-start’. There is rarely any bleeding, but if this complication does occur, it is usually minimal. You will be able to talk as normal following the treatment and swallowing is only slightly affected by numbness. Five or ten minutes after the procedure you are free to leave the clinic. Once home, it is best to avoid hot drinks until the local anaesthetic has worn off.

If you have a general anaesthetic you will be able to leave hospital the same day. As you will be unable to drive for 24 hours please make sure you have arranged transport home. Your surgeon will discuss postoperative do's and don’ts before you leave and you will be given a detailed information sheet.

Pain relief

A series of painkillers will be prescribed for you and should be strictly adhered to. If you do not deviate from the regime, your pain will be well controlled.

Going to work the next day is routine and soreness reaches a peak at around 4-5 days after the operation. Time off work is rare, thanks to the effectiveness of the painkilling regime, which has been developed by the LLC over the past 2 years.

The full effect of the operation will be noticed by approximately 1 month, and some pain is often present for up to 14 days after surgery. Occasionally snoring is worse for 1 to 2 days after treatment, due to slight swelling of the remaining soft palate.

A change in sensation, such as a feeling of a lump at the back of the throat and dryness in the back of the throat may occur. This will wear off gradually, taking around 3 months, but does not cause undue distress. Along with an almost complete inability to make the classical snoring sound awake or asleep, you may also notice other benefits from this procedure. These may include feeling much more refreshed on rising after sleep, improved nose and mouth breathing, loss of catarrhal symptoms, and losing the chronic sensation of blockage or lump at the back of the throat.

The complications of other snoring operations such as regurgitation of fluid through the nose after surgery, or prolonged difficulty swallowing have not been experienced by any of our patients. We feel that the LAUP procedure and its modifications are the safest and best way of treating adult snoring.

An audit of 200 patients recently showed a >90% complete patient (and partner) satisfaction in terms of snoring abolition. The same success rate was seen with improvement in general sleep. The other symptoms mentioned were improved in around 60% of cases.

Post Operative Care

This procedure is, suprisingly, very straightforward. There is no real pain during or after, speech and swallowing are normal. Before you leave, your surgeon will check your throat and make sure that you are happy to leave, and that you understand how to take the painkillers and gargles that have been prescribed. 

After a few hours the throat will become slightly sore, and at this stage you can start the painkillers.

You will be recovering for about 10 - 14 days and it is best to avoid citrus-based products (lemons, oranges), spicy food and fizzy drinks during this time. Otherwise, eat whatever you like, it is advisable to eat "sharp" foods, such as toast, crisps etc. since this will accelerate healing.

After the first few days you may notice white material at the back of the throat. Do not worry, this is completely normal healing tissue, and does not represent infection or complication. It is usually gone by around 7 days postoperatively.

As time progresses, the pain will worsen until it reaches a peak at around day 4 or 5. By this stage you will need to take the stronger painkillers. Pain is usually not continuous, but appears mainly during swallowing, yawning, laughing, burping. During this time most people are able to go to work and function normally. After a period of another 4 days, this pain begins to subside, and is usually gone by around day 10.

Bleeding is usually the only complication of this procedure, and is very rare (incidence is <1%). However if you do suffer bleeding, gargle with the ‘Difflam’ antiseptic for approximately 30 seconds. If there is no improvement after about 10 minutes, go to your nearest Accident and Emergency department. Also call your surgeon (via the Hospital of St. John and St. Elizabeth switchboard) who will liase with the hospital staff.

You will be required to make an appointment for a follow up examination at around 4 weeks postoperatively.

Graphic examples of LAUP

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Laser Skin Resurfacing example 1

Pre-operative	3 days Post-operative	2 weeks Post-operative	Final Post-operative, showing a shortened and stiffened soft palate

To view pricing information for this procedure, click here.