Surgeon's Guide: Uvulopalatopharyngoplasty (UPPP)

Last week, we reviewed a range of non-surgical and surgical treatment options for OSA, read that here. We want to now delve into specific procedures in greater detail, starting with uvulopalatopharyngoplasty, or UPPP. This is the most common surgery I (CG) perform—a true workhorse in OSA surgery practice.

A Longstanding Procedure, Reappraised

UPPP has a long history in the field, with mixed appreciation for its role in treatment. For a long time, it was dismissed by sleep specialists due to inconsistent results—typically this was measured by the simplistic metric of OSA “cure.” As mentioned in a prior post, the fixation with AHI score and “cure” as success is overly simplified and outdated. As our understanding of OSA has evolved, so has our appreciation of UPPP’s role in significantly decreasing snoring, and improving quality of life and health outcomes. As the American Academy of Otolaryngology - Head and Neck Surgeons summarized in their position statement:

UPPP confers improved survival and reduction in risk of serious or fatal cardiovascular events in cohort and large national population studies. UPPP has been shown to reduce sleepiness, motor vehicle accident risk and improve overall quality of life.

Unfortunately, the surgery still struggles with its reputation. Patients will often respond quite viscerally/negatively when I bring it up. They’ve been told it ‘doesn’t work’ or had providers/contacts tell them to avoid it. It’s important for surgeons to be able to speak to where UPPP fits into the treatment armamentarium for OSA and give patients a level-headed review of its pros and cons.

Patient Selection is Key

Successful outcomes depend heavily on selecting the right candidates. Several clinical staging classification systems have been used to try to optimize success. Large tonsils, normal weight, and non-recessed jaw patients tend to do exceedingly well. If those criteria are met, I typically quote UPPP to provide 50-75% improvements. In practice, this typically means we take a severe OSA patient to mild-moderate, with significant improvements (not cure) of snoring and high patient satisfaction. This is why it is the most common surgery that I do.

What the Procedure Involves

UPPP includes removal of the tonsils, partial or full removal of the uvula, and repositioning of the pharyngeal soft tissues. Countless unique suture and dissection techniques have been described, all with similar results. The ultimate goal is to widen the oropharyngeal airway and reduce the obstruction that contributes to OSA and snoring. Below is an example of the technique we (CG/RC) typically utilize, published in academic literature.

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What to Expect After Surgery

Pain

This is one of the most painful surgeries we perform. Most patients require narcotic pain medication, and it’s common to need two weeks off from work or school to recover.

Diet

Swallowing is painful, especially in the first week. Patients often stick with soft, cool, and soothing foods like smoothies, yogurt, and soups. Water intake is critical to healing and comfort.

Activity

Fatigue is common postoperatively. Most patients are resting at home for at least 10–14 days. Heavy lifting or strenuous activity should be avoided for 10 days or more. Many patients find it more comfortable to sleep with their head elevated during recovery.

Postoperative Complications

Some blood-tinged saliva is expected in the first week. However, less than 5% of patients experience significant postoperative bleeding. In rare cases, patients may require an emergency visit or repeat operative procedure to control.

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This is a foundational procedure in sleep surgery that, when performed on the right patient, offers meaningful improvement in symptoms and quality of life. We will continue to share our view on current and future surgical procedures. Stay tuned.

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🧐 Frequently Asked Questions About UPPP

1. Will UPPP cure my sleep apnea?
Not usually. UPPP is aimed at reducing the severity of OSA—not curing it. The goal is to improve symptoms, reduce health risks, and sometimes eliminate the need for CPAP in select patients.

2. How long is the recovery period?
Most patients need 10–14 days off work or school. Pain is significant- often lasting 2-3 weeks.

3. What kind of anesthesia is used?
UPPP is performed under general anesthesia, meaning you’ll be fully asleep and monitored throughout the surgery. It is an outpatient surgery- you’ll go home the same day.

4. What are the risks?
The most common risks include bleeding, pain, and temporary swallowing difficulty. Serious bleeding is uncommon but can occur in the first 10 days, rarely requiring Emergency Department visit or reoperation.