Laser snoring treatment - laser uvulopalatoplasty

In the last decade and a half, medical lasers have been widely used to solve the problem of ronchopathy. Laser treatment of snoring – the method of laser uvulopalatoplasty – is aimed at increasing the lumen of the airway in the oropharynx and reducing the volume of soft tissues that create an obstacle to the air flow, vibrate during inhalation and exhalation, causing a characteristic sound.

Indications for the procedure

Outpatient laser snoring surgery involves reducing and changing the soft palate process - the uvula - and the soft palate itself (velum palatinum). Therefore, the indications for this procedure are primary snoring, which occurs due to a decrease in the size of the oropharyngeal airway, which is caused either by anatomical features of the oropharynx or by an increase in the volume (hypertrophy) of the tissues of the uvula, soft palate, and sometimes the back wall of the pharynx. [ 1 ]

There are several methods, and the choice depends on the individual characteristics of each patient.

Preparation

Before making a decision on laser snoring treatment, patients undergo an appropriate otolaryngological examination and throat examination, including instrumental examination.

To clarify the scope of the procedure and the localization of the impact, the exact anatomical structure of the oropharynx is determined - the uvula and the palatine arches (palatoglossal and palatopharyngeal) - using the Mallampati classification: a visual assessment of the distance from the base of the tongue to the top of the oral cavity and the location of the uvula, which are visible when the patient opens the mouth.

To prevent serious bleeding, preparation includes stopping taking aspirin, nonsteroidal anti-inflammatory drugs, and herbal remedies that reduce blood clotting two weeks before surgery. [ 2 ]

Technique Laser snoring treatment - laser uvulopalatoplasty

The technique of performing the operation depends on the chosen method, and today such procedures for reducing the volume of soft tissues of the oropharyngeal anatomical structures include three main methods.

The most invasive is laser-assisted uvulopalatoplasty or uvulopalatopharyngoplasty (LA-UPPP) using a carbon dioxide ablative laser and a radiofrequency probe. The procedure lasts up to half an hour and is performed under local anesthesia. [ 3 ]

The technique of the LAUP method – laser uvulopalatoplasty using a long-pulse neodymium Nd:YAG laser – consists of scarification (breaking the integrity of the tissue) of the soft palate by evaporating the mucous membrane and submucosal tissues along a rectangle (1.5-2 cm wide) that extends from the palatine fossa to the uvula. For visible results, three laser treatment sessions are required: the second after two weeks, the third after 45 days. [ 4 ]

A more modern and less invasive (the procedure does not require anesthesia) is considered to be the non-ablative Nightlase method. It uses a short-pulse Erbium laser Er:YAG (with a wavelength of 2940 nm) - with a contactless effect on the tissues of the tongue, root of the tongue, soft palate, lateral and posterior walls of the pharynx. The spot of the collimated laser beam emerging from the tip is moved from one anatomical area to another. The photothermal effect, which consists of heating the treated areas to + 45-65 ° C, causes compression of the collagen fibers of the mucous membrane with subsequent neocollagenesis - the formation of denser collagen. [ 5 ]

Contraindications to the procedure

Laser treatment of snoring is contraindicated:

• in case of obesity with a body mass index over 35;
• in case of severe shortness of breath and respiratory failure;
• for sleep apnea syndrome;
• in case of acute inflammation of the throat (tonsillitis, pharyngitis) or exacerbation of chronic inflammatory ENT diseases;
• in case of presence of scars in the oropharynx,
• in case of psychoneurological pathologies and mental disorders;
• in diabetes mellitus;
• with increased gag reflex;
• in the presence of oncological diseases;
• if you are taking medications that increase photosensitivity;
• pregnant women and patients under 18 years of age.

Consequences after the procedure

As with any procedure that involves violating the integrity of the mucous membrane of the upper respiratory tract, complications after laser uvulopalatoplasty may include:

• bleeding;
• swelling of the mucous membrane of the oropharynx and the resulting regurgitation (swallowed liquid entering the nose);
• inflammation of the mucous membrane of the throat in case of infection;
• dry throat or a feeling of a foreign body in the throat;
• temporary change in phonation (voice formation) due to developing velopharyngeal insufficiency, which leads to nasal speech;
• dysgeusia (change in taste);
• dysosmia (impaired sense of smell).

Complications after the procedure

As with any procedure that involves violating the integrity of the mucous membrane of the upper respiratory tract, complications after laser uvulopalatoplasty may include:

• bleeding;
• swelling of the mucous membrane of the oropharynx and the resulting regurgitation (swallowed liquid entering the nose);
• inflammation of the mucous membrane of the throat in case of infection;
• dry throat or a feeling of a foreign body in the throat;
• temporary change in phonation (voice formation) due to developing velopharyngeal insufficiency, which leads to nasal speech;
• dysgeusia (change in taste);
• dysosmia (impaired sense of smell).

Care after the procedure

After the laser uvulopalatoplasty procedure, patients should:

• control pain with analgesics and also by cooling the mouth with ice (holding ice cubes in the mouth);
• eat properly, that is, consume liquid food during the first five to six days after surgery;
• drink more fluids (water and juices at room temperature);
• the first few days – to reduce swelling – sleep with your head raised at 45 degrees (put an extra pillow);
• reduce physical activity for three weeks;

For about a month after the procedure, you should not use mouthwashes, throat lozenges or sprays, or drink alcohol, which can irritate the mucous membrane. [ 6 ]

Reviews

It should be borne in mind that laser snoring treatment does not give a 100% positive result. For example, positive feedback from patients who have used the NightLase method is 74%.