Last updated: 11/24/2009

With the exception of UPPP, all of the surgical treatments for snoring described in this section are outpatient or office-based procedures.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty, or UPPP, is the oldest and most invasive surgical treatment for snoring. It was first performed in 1982 by a Japanese surgeon named S. Fujita. UPPP requires general anesthesia, one to two nights of inpatient care in a hospital, and a minimum of two weeks of recovery afterward. In a uvulopalatopharyngoplasty, the surgeon resects (removes) the patient's tonsils, part of the soft palate, and the uvula. The procedure works by enlarging the airway and removing some of the soft tissue that vibrates when the patient snores. It is not effective in treating snoring caused by obstructions at the base of the tongue.

UPPP has several drawbacks in addition to its cost and lengthy recovery period. It can result in major complications, including severe bleeding due to removal of the tonsils as well as airway obstruction. In addition, the results may not be permanent; between 50% and 70% of patients who have been treated with UPPP report that short-term improvements in snoring do not last longer than a year.

Laser-assisted uvulopalatoplasty

Laser-assisted uvulopalatoplasty, or LAUP, is an out-patient surgical treatment for snoring in which a carbon dioxide laser is used to vaporize part of the uvula, a small triangular piece of tissue that hangs from the soft palate above the back of the tongue. The patient is seated upright in a comfortable chair in the doctor's office. The doctor first sprays a local anesthetic—usually lidocaine—over the back of the patient's throat, covering the patient's soft palate, tonsils, and uvula. The second step is the injection of more anesthetic into the muscle tissue in the uvula. After waiting for the anesthetic to take effect, the surgeon uses a carbon dioxide laser to make two vertical incisions in the soft palate on either side of the uvula. A third incision is used to remove the tip of the uvula. The surgeon also usually removes part of the soft palate itself. The total procedure takes about half an hour.

LAUP is typically performed as a series of three to five separate treatments. Additional treatment sessions, if needed, are spaced four to eight weeks apart.

LAUP was developed in the late 1980s by Dr. Yves-Victor Kamami, a French surgeon whose first article on the technique was published in 1990. Kamami claimed a high rate of success for LAUP in treating a condition known as obstructive sleep apnea (OSA) as well as snoring. The procedure has become controversial because other surgeons found it less effective than the first reports indicated, and also because most patients suffer considerable pain for about two weeks after surgery. Although some surgeons report a success rate as high as 85% in treating snoring with LAUP, the effectiveness of the procedure is highly dependent on the surgeon's experience and ability.

Somnoplasty

Somnoplasty, or radiofrequency volumetric tissue reduction (RFVTR) is a newer technique in which the surgeon uses a thin needle connected to a source of radiofrequency signals to shrink the tissues in the soft palate, throat, or tongue. It was approved by the Food and Drug Administration (FDA) for the treatment of snoring in 1997. The needle is inserted beneath the surface layer of cells and heated to a temperature between 158°F (70°C) and 176°F (80°C). The upper layer of cells is unaffected, but the heated tissue is destroyed and gradually reabsorbed by the body over the next four to six weeks. Somnoplasty stiffens the remaining layers of tissue as well as reducing the total volume of tissue. Some patients require a second treatment, but most find that their snoring is significantly improved after only one. The procedure takes about 30 minutes and is performed under local anesthesia.

Somnoplasty appears to have a higher success rate (about 85%) than LAUP and is considerably less painful. Most patients report two to three days of mild swelling after somnoplasty compared to two weeks of considerable discomfort for LAUP.

Tongue suspension procedure

The tongue suspension procedure, which is also known as the Repose™ system, is a minimally invasive surgical treatment for snoring that stabilizes the base of the tongue during sleep, preventing it from falling backward and obstructing the airway. The Repose system was approved by the FDA in 1998. It consists of a titanium screw inserted into the lower jaw on the floor of the mouth and a suture passed through the base of the tongue that is then attached to the screw. The attachment holds the tongue forward during sleep.

The Repose system is done as an outpatient procedure under total anesthesia. It takes about 15–20 minutes to complete. The advantages of the tongue suspension procedure include the fact that it is reversible, since no incision is made; and that it can be combined with UPPP, LAUP, or a tonsillectomy. Its disadvantages include its relatively long healing time (one to two weeks) and the fact that it appears to be more effective in treating OSA than primary snoring. One team of American and Israeli researchers who conducted a multicenter trial concluded that the tongue suspension procedure requires further evaluation.

Injection snoreplasty

Injection snoreplasty was developed by a team of Army physicians at Walter Reed Hospital and introduced to other ear, nose and throat specialists at a professional conference in 2000. In injection snoreplasty, the surgeon gives the patient a local anesthetic and then injects a hardening agent known as sodium tetradecyl sulfate underneath the skin of the roof of the mouth just in front of the uvula. The chemical, which is also used in sclerotherapy, creates a blister that hardens into scar tissue. The scar tissue pulls the uvula forward, reducing the vibration or flutter that causes snoring.

Preliminary research indicates that injection snore-plasty is safe, has a higher rate of success than LAUP (about 92%), and is also less painful. Most patients need only one treatment, and can manage the discomfort the next day with a mild aspirin substitute and throat spray. The primary drawback of injection snoreplasty is that it treats only tissues in the area of the uvula. Snoring caused by tissue vibrations elsewhere in the throat requires another form of treatment. Injection snoreplasty costs about $500 per treatment.