Laser sculptural uvulopalatoplasty is an effective method of treating patients with ronchopathy and obstructive sleep apnea
https://doi.org/10.21518/ms2025-028
Abstract
Introduction. Surgical treatment of patients with ronchopathy and obstructive sleep apnea syndrome (OSAS) is a topical issue of modern medicine. The velopharyngeal muscle injury of various intensity due to surgical interventions on the soft palate leads to inflammation, tissue necrosis or partial rejection and wound healing with a fibrous scar, muscle hypotrophy and hypotonia, palatal ptosis and, as a consequence of this, disease recurrence.
Aim. To evaluate the effectiveness of laser surgery on the soft palate in patients with ronchopathy and obstructive sleep apnea syndrome.
Materials and methods. The results of examination and treatment of 523 patients with ronchopathy and obstructive sleep apnea syndrome of varying severity aged from 23 to 78 years (men 299, women 224) are presented. Surgical intervention on the soft palate was performed in 352 (67.3%) patients: 309 underwent laser sculptural uvulopalatoplasty, 43 underwent surgery using the Remacl method M. et al. (comparison group).
Results and discussion. A comparative analysis of subjective and objective indicators obtained in the same patients according to monitoring computer pulse oximetry, polysomnography and computer somnography before and at different times after laser sculptural uvulopalatoplasty demonstrates persistent and significant (p ≥ 0.005) positive changes. The data from the study of patients in the comparison group demonstrate a positive trend in the results obtained at different times after Remacl surgery M. et al. only if they have uncomplicated snoring and mild OSA.
Conclusion. Laser sculptural uvulopalatoplasty is a highly effective method of treating patients with ronchopathy, regardless of the presence and degree of obstructive sleep apnea syndrome. With high-quality and adequate selection for surgery, accurate determination of the levels of obstruction, shape and degree of collapse of the soft tissues of the upper respiratory tract, careful consideration of the individual characteristics of the structure of the soft palate and pharynx and minimization of surgical trauma to the palatine curtain, it is possible to achieve a positive effect of surgery in the vast majority of patients.
About the Author
V. B. KnyazkovRussian Federation
Vladimir B. Knyazkov, Cand. Sci. (Med.), Junior Researcher at the Laboratory of Minimally Invasive Surgery of the Research Institute of Technobiomed NOI of Medical Technologies named after S.N. Fedorov
4, Dolgorukovskaya St., Moscow, 119048
References
1. Partinen M, Guilleminault С. Evolution of obstructive sleep apnea syndrome. In: Obstructive sleep apnea syndrome: clinical research and treatment. New York: Raven Press; 1990, pp. 15–23. Available at: https://researchportal.helsinki.fi/en/publications/evolution-of-obstructive-sleep-apnea-syndrome.
2. Зильбер АП. Синдромы сонного апноэ. Петрозаводск; 1994. 183 с.
3. Ovchinnikov YuM, Fishkin DV. Variants of surgical treatment of snoring and sleep apnea. Vestnik Oto-Rino-Laringologii. 2000;(4):51–53. (In Russ.)
4. Karpishchenko SA, Ryabova MA, Ulupov MY. Laser surgery in otolaryngology at the present stage. Consilium Medicum. 2014;16(11):73–76. (In Russ.) Available at: https://consilium.orscience.ru/2075-1753/article/view/94195.
5. Nasedkin AN. Laser surgery of snoring (17 years of experience). Laser Medicine. 2014;18(4):57. (In Russ.) Available at: https://www.elibrary.ru/tqmwkp.
6. Свистушкин ВМ, Фишкин ДВ, Будейкина ЛС. Современные аспекты хирургического лечения больных храпом и СОАС. В: Полуэктов МГ, Стрыгин КН (ред.). Актуальные проблемы сомнологии: сборник тезисов X Всероссийской конференции. Москва, 16–17 ноября 2016 г. М.; 2016. С. 99–100. Режим доступа: https://www.elibrary.ru/aofggy.
7. Wischhusen J, Qureshi U, Camacho M. Laser-assisted uvulopalatoplasty (LAUP) complications and side effects: A systematic review. Nat Sci Sleep. 2019;11:59–67. https://doi.org/10.2147/NSS.S178540.
8. Knyazkov VB, Prazdnikov EN, Daikhes NA. Reasons for failure in surgical treatment of patients with rhonchopathy and obstructive sleep apnea syndrome. Laser Medicine. 2022;26(3-4):38–46. (In Russ.) https://doi.org/10.37895/2071-8004-2022-26-3-4-38-46.
9. Fairbanks DNF, Fujita S, Ikematsu T, Simmons FB. Snoring and obstructive sleep apnea. New York: Raven Press; 1987. 268 p.
10. Macaluso RA, Reams C, Gibson WS, Vrabec DP, Matragrano A. Uvulopalatopharyngoplasty: postoperative management and evaluation of results. Ann Otol Rhinol Laryngol. 1989;98(7):502–507. https://doi.org/10.1177/000348948909800703.
11. Larsson H, Carlsson-Nordlander B, Svanborg E. Long-time follow-up after UPPP for obstructive sleep apnea syndrome. Results of sleep apnea recordings and subjective evaluation 6 months and 2 years after surgery. Acta Otolaryngol. 1991;111(3):582–590. https://doi.org/10.3109/00016489109138387.
12. Ferguson KA, Heighway K, Ruby RR. A randomized trial of laser-assisted uvulopalatoplasty in the treatment of mild obstructive sleep apnea. Am J Respir Crit Care Med. 2003;167(1):15–19. https://doi.org/10.1164/rccm.2108050.
13. Littner M, Kushida CA, Hartse K, Anderson WM, Davila D, Johnson SF et al. Practice parameters for the use of laser-assisted uvulopalatoplasty: an update for 2000. Sleep. 2001;24(5):603–619. htpp://doi.org/10.1093/sleep/24.5.603.
14. Knyazkov VB, Prazdnikov EN, Daĭkhes NA. Selection of patients with snoring and obstructive sleep apnea syndrome for laser sculptural uvulopalatoplasty. Russian Journal of Operative Surgery and Clinical Anatomy. 2023;7(2):19–25. (In Russ.) https://doi.org/10.17116/operhirurg2023702119.
15. Knyazkov VB, Prazdnikov EN, Daikhes NA. Anatomical and physiological justification of laser sculptural uvulopalatoplasty in rhonchopathy and obstructive sleep apnea syndrome. Laser Medicine. 2023;27(1):39–45. (In Russ.) https://doi.org/10.37895/2071-8004-2023-27-1-39-45.
16. Knyazkov VB, Prazdnikov EN, Dayhes NA. Optimization of laser exposure parameters during surgical correction of soft palate tissues in patients with ronchopathy and obstructive sleep apnea syndrome. Vestnik Oto-Rino-Laringologii. 2023;88(5):34–40. (In Russ.) https://doi.org/10.17116/otorino20238805134.
17. Knyazkov VB. Ways to increase the effectiveness of uvulopalatoplasty in patients with ronchopathy and obstructive sleep apnea syndrome. Meditsinskiy Sovet. 2025;19(7):8–12. (In Russ.) https://doi.org/10.21518/ms2024-553.
18. Knyazkov VB, Prazdnikov EN, Stakhanov ML, Daĭkhes NA. Laser sculptural uvulopalatoplasty as a new method of surgical treatment of snoring and obstructive sleep apnea syndrome. Russian Journal of Operative Surgery and Clinical Anatomy. 2023;7(1):5–12. (In Russ.) https://doi.org/10.17116/operhirurg202370115.
19. Remacle M, Betsch C, Lawson G, Jamart J, Eloy P. A new technique for laser-assisted uvulopalatoplasty: decision-tree analysis and results. Laryngoscope. 1999;109(5):763–768. https://doi.org/10.1097/00005537-199905000-00015.
20. Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope. 2003;113(11):1961–1968. https://doi.org/10.1097/00005537-200311000-00020.
21. Friedman M, Ibrahim HZ, Vidyasagar R, Pomeranz J, Joseph NJ. Z-palatoplasty (ZPP): a technique for patients without tonsils. Otolaryngol Head Neck Surg. 2004;131(1):89–100. https://doi.org/10.1016/j.otohns.2004.02.051.
22. Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic azb-normalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981;89(6):923–934. https://doi.org/10.1177/019459988108900609.
23. Li HY, Chen NH, Shu YH, Wang PC. Changes in quality of life and respiratory disturbance after extended uvulopalatal flap surgery in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2004;130(2):195–200. https://doi.org/10.1001/archotol.130.2.195.
24. Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2007;137(1):110–114. https://doi.org/10.1016/j.otohns.2007.03.014.
25. Kamami YV. Laser CO2 for snoring. Preliminary results. Acta Otorhinolaryngol Belg. 1990;44(4):451–456. Available at: https://pubmed.ncbi.nlm.nih.gov/2128762.
26. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–545. https://doi.org/10.1093/sleep/14.6.540.
27. Ellis PD. Laser palatoplasty for snoring due to palatal flutter: a further report. Clin Otolaryngol Allied Sci. 1994;19(4):350–351. https://doi.org/10.1111/j.1365-2273.1994.tb01245.x.
28. Krespi YP, Pearlman SJ, Keidar A. Laser-assisted uvula-palatoplasty for snoring. J Otolaryngol. 1994;23(5):328–334. Available at: https://pubmed.ncbi.nlm.nih.gov/7807636.
29. Walker RP, Grigg-Damberger MM, Gopalsami C. Uvulopalatopharyngoplasty versus laser-assisted uvulopalatoplasty for the treatment of obstructive sleep apnea. Laryngoscope. 1997;107(1):76–82. https://doi.org/10.1097/00005537-199701000-00016.
Review
For citations:
Knyazkov VB. Laser sculptural uvulopalatoplasty is an effective method of treating patients with ronchopathy and obstructive sleep apnea. Meditsinskiy sovet = Medical Council. (In Russ.) https://doi.org/10.21518/ms2025-028