Arco-palato-uvular flap: a new surgical technique for the treatment of palatal snoring in tonsillectomized patients.

Objectives: We describe a new surgical technique called "arco-palato-uvular flap (APUF)" which can be used for the surgical management of palatal snoring in previously tonsillectomized patients.

Patients And Methods: Among patients who were admitted to the Military Hospital of Novi Sad between January 2000 and December 2004, 36 patients (19 males, 17 females; mean age 45.3 years; range 21 to 60 years) who had previously undergone tonsillectomy for various reasons and who were thought to have palatal snoring based on physical and endoscopic examinations were evaluated on the basis of the visual analog scale (VAS), Epworth sleepiness scale (EPSS) and apnea hypopnea index (AHI) scores and underwent APUF surgery after giving informed consent.

Results: Twenty-seven patients with a body mass index (BMI) of <30 kg/m2 had socially-bothersome snoring and nine had mild sleep apnea (AHI 5-15/hour, SO2 >90%). The mean visual analog scale scores were 8.6 ± 1.0 preoperatively and 2.3 ± 1.5 postoperatively. The Epworth Sleepiness Scale scores averaged 10.0 ± 3.0 preoperatively and 4.0 ± 1.0 postoperatively. In patients with mild apnea, the average preoperative AHI was 11.58 ± 3.58 and dropped to 4.75 ± 2.92 postoperatively. Statistical analysis revealed significant reductions in all variables (p<0.001).

Conclusion: The APUF procedure may treat palatal snoring and mild obstructive sleep apnea in previously tonsillectomized patients by widening the oropharyngeal airway, and stabilizing the uvulopalatal segment. Further studies are needed to determine the long-term success rates of the technique and to modify the patient selection and exclusion criteria.