Laser snoring treatment - laser uvulopalatoplasty

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

Indications for the procedure

Outpatient laser snoring surgery consists in the reduction and modification of the uvula (uvula) and the soft palate (velum palatinum). Therefore, the indication for this procedure is the primary snoring, arising 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 tissues of the uvula, soft palate, and sometimes the posterior pharyngeal wall. [1]

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

Preparation

Before deciding on laser snoring treatment, patients undergo appropriate otorhinolaryngologic examination and examination of the pharynx, including instrumental examination.

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

To prevent serious bleeding, preparation includes stopping acetylsalicylic acid, 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 the operation depends on the chosen method, and to date, such procedures to reduce the volume of soft tissues of oropharyngeal anatomical structures include three main techniques.

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

The technique of LAUP - laser uvulopalatoplasty using a long-pulse neodymium Nd: YAG laser - consists of scarification (disruption of tissue integrity) of the soft palate by vaporizing the mucosa and submucosa along a rectangle (1.5-2 cm wide) that extends from the palatal fossa to the uvula. Three laser treatment sessions are required for visible results: the second after two weeks and the third after 45 days. [4]

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

Contraindications to the procedure

Treatment of snoring with a laser is contraindicated:

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

Consequences after the procedure

As with any procedure involving disruption of the integrity of the upper respiratory mucosa, there may be complications from the laser uvulopalatoplasty procedure such as:

• bleeding;
• swelling of the oropharyngeal mucosa and the resulting regurgitation (ingested liquid entering the nose);
• inflammation of the throat mucosa in case of infection;
• dry throat or a sensation of a foreign body in the throat;
• A temporary change in phonation (vocalization) due to developing velopharyngeal insufficiency, which leads to nasality;
• dysgeusia (change in taste);
• Dysosmia (odor perception disorders).

Complications after the procedure

As with any procedure involving disruption of the integrity of the upper respiratory mucosa, there may be complications after a laser uvulopalatoplasty procedure such as:

• bleeding;
• swelling of the oropharyngeal mucosa and the resulting regurgitation (ingested liquid entering the nose);
• inflammation of the throat mucosa in case of infection;
• dry throat or a sensation of a foreign body in the throat;
• A temporary change in phonation (voice formation) due to developing velopharyngeal insufficiency, which leads to nasality;
• dysgeusia (change in taste);
• Dysosmia (odor perception disorders).

Care after the procedure

After the laser uvulopalatoplasty procedure, patients should:

• control pain with analgesics and by cooling the mouth with ice (keep food ice in the mouth);
• eat properly, i.e. Eat liquid food for the first five to six days after surgery;
• Drink more fluids (water and room temperature juices);
• for the first few days - to reduce swelling - sleep with the head raised 45 degrees (put an extra pillow);
• reduce physical activity for three weeks;

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

Testimonials

It should be borne in mind that 100% positive results of laser treatment of snoring do not give. For example, the positive feedback from patients who received NightLase method is 74%.