Laser snoring treatment - laser uvulopalatoplasty

In the last decade and a half, medical lasers have been widely used to solve the problem of ronchopathy. Treatment of snoring with a laser - 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 a barrier to air flow, vibrate during inhalation and exhalation, causing a characteristic sound.

Indications for the procedure

An outpatient operation for snoring with a laser consists in reducing and changing the process of the soft palate - the tongue (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 due either to the anatomical features of the oropharynx, or an increase in the volume (hypertrophy) of the tissues of the tongue, soft palate, and sometimes the posterior pharyngeal wall. [1]

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

Preparation

Before making a decision to treat snoring with a laser, patients undergo an appropriate otorhinolaryngological examination and examination of the pharynx, including instrumental.

To clarify the scope of the procedure and the localization of the impact, the exact anatomical structure of the oropharynx - the uvula and palatine arches (palatoglossal and palatopharyngeal) - is determined 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 palatine uvula, which are visible when the patient opens his mouth.

To prevent serious bleeding, preparation includes stopping the use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs, and herbal medicines that reduce blood clotting two weeks before surgery. [2]

Technique Laser snoring treatment - laser uvulopalatoplasty

The technique of the operation depends on the chosen method, and today such procedures for reducing the volume of soft tissues of 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 an RF 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 in scarification (violation of tissue integrity) of the soft palate by evaporation of the mucous membrane and tissues of the submucosal layer along a rectangle (1.5-2 cm wide) that extends from the palatine pits to tongue. For visible results, three sessions of laser treatment are required: the second - after two weeks, the third - after 45 days. [4]

More modern and less invasive (the procedure does not require anesthesia) is the non-ablative Nightlase technique. It uses a short-pulse erbium laser Er:YAG (with a wavelength of 2940 nm) - with a non-contact effect on the tissues of the uvula, tongue root, 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 region to another. The photothermal effect, which consists in heating the treated areas to + 45-65 ° C, causes contraction of the collagen fibers of the mucous membrane, followed by neocollagenesis - the formation of denser collagen. [5]

Contraindications to the procedure

Treatment of snoring with a laser is contraindicated:

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

Consequences after the procedure

As with any procedure with a violation of the integrity of the mucous membrane of the upper respiratory tract, there may be such complications after the laser uvulopalatoplasty procedure, such as:

• bleeding;
• swelling of the mucous membrane of the oropharynx and the resulting regurgitation (ingestion of swallowed liquid into the nose);
• inflammation of the throat mucosa in case of infection;
• dryness in the throat or a feeling of having a foreign body in it;
• temporary change in phonation (voice formation) due to developing velo-pharyngeal insufficiency, which leads to nasality;
• dysgeusia (change in taste);
• dysosmia (impaired odor perception).

Complications after the procedure

As with any procedure with a violation of the integrity of the mucous membrane of the upper respiratory tract, there may be such complications after the laser uvulopalatoplasty procedure, such as:

• bleeding;
• swelling of the mucous membrane of the oropharynx and the resulting regurgitation (ingestion of swallowed liquid into the nose);
• inflammation of the throat mucosa in case of infection;
• dryness in the throat or a feeling of having a foreign body in it;
• temporary change in phonation (voice formation) due to developing velo-pharyngeal insufficiency, which leads to nasality;
• dysgeusia (change in taste);
• dysosmia (impaired odor perception).

Care after the procedure

After laser uvulopalatoplasty, patients should:

• control pain with analgesics, as well as cooling the oral cavity with ice (keep food ice in the mouth);
• eat right, that is, consume liquid food during the first five to six days after the operation;
• drink more fluids (water and juices at room temperature);
• the first few days - to reduce swelling - sleep with your head raised 45 degrees (put an extra pillow);
• reduce physical activity within three weeks;

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

Reviews

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