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Palate Procedures for Obstructive Sleep Apnea

Obstructive sleep apnea

Palate surgery is one of the surgical options available for the treatment of obstructive sleep apnea (OSA). If other treatments for sleep apnea haven’t worked for you, it’s important to research solutions like palate surgery. 

From details of what the palate surgery is to how exactly it works, here is everything you need to know about this surgery for sleep apnea.

What is Palate Surgery?

The soft palate (roof of the mouth) can play an important role in blocking breathing in patients with obstructive sleep apnea. Palate surgery includes a group of procedures that are generally performed under general anesthesia in the operating room. This surgery for sleep apnea is combined with tonsillectomy in most patients who have tonsils that have not previously been removed. 

Palate surgery can be performed alone or in combination with hypopharyngeal procedures. These palate procedures involve a combination of tissue removal and tissue repositioning that aims to increase the size of the airway without affecting normal functions such as breathing, speaking, and swallowing. 

Types of Palate Surgery

Uvulopalatopharyngoplasty (UPPP) 

UPPP was the first procedure used to treat obstructive sleep apnea. This surgery for sleep apnea includes removal of the uvula and a portion of the soft palate, as well as sewing together the cut edges of the remaining portion of the soft palate and sides of the throat.

Compared to other OSA surgeries, UPPP typically involves more tissue removal from the soft palate.

Expansion Sphincter Pharyngoplasty

Expansion sphincter pharyngoplasty involves more tissue repositioning and almost no tissue removal.

In this surgery for sleep apnea, the muscle that is directly behind the tonsil (palatopharyngeus muscle) is freed up from the side of the throat and moved forward. Because it is still attached to the soft palate, it pulls the soft palate forward to open the area behind the soft palate for breathing.

In a randomized trial comparing expansion sphincter pharyngoplasty to UPPP, this procedure showed better results than UPPP in certain types of patients.

Sleep apnea patient in surgery

Lateral Pharyngoplasty

This surgery for sleep apnea involves extensive repositioning of tissue of the soft palate, as well as the lateral pharyngeal tissues (side of the throat). Only some tissue removal is required.

Although lateral pharyngoplasty can be more intimidating because of how involved it is, it has shown better results among certain patients in a randomized trial comparing it to UPPP.

The Pillar Procedure

Pillar surgery for sleep apnea typically involves the insertion of 3-5 braided polyester implants (pillars) into the soft palate at the back of the mouth. Each implant is 18 mm (3/4 inch) long and is made of a polyester material that has been used in other medical implants for decades.

The Pillar Procedure is usually performed in a surgeon’s office, which is one of its advantages. 

Recent research has examined the benefits of this surgery for sleep apnea, showing that there are certain patients that seem to benefit more than others. The most favorable patients tend to be those with small tonsils (or who had them removed already) who are not excessively overweight.

Doctor consulting with OSA patient

Uvulopalatal Flap

Uvulopalatal Flap is a treatment for sleep apnea that can be used in patients with thin, soft palates. The procedure involves almost no removal of muscle of the soft palate. Instead, the lining of the mouth (mucosa) found on a portion of the soft palate, as well as the uvula are removed to allow a folding of the soft palate muscle onto itself. 

Effectively, it makes the soft palate shorter without removing muscle. Muscle removal is avoided because it can likely affect swallowing in these patients.

Palatal Advancement Pharyngoplasty 

This surgery for sleep apnea treats the palate by removing some of the bone towards the back of the roof of the mouth (hard palate). After removal of the bone, the soft palate is then pulled forward and sewn into place. This opens the space for breathing behind the soft palate in a slightly different way.

Hypopharyngeal procedures and jaw advancement surgery are similar treatments for sleep apnea that also may be an option for patients with obstructive sleep apnea.

Z-Palatoplasty

This surgery for sleep apnea requires dividing part of the soft palate in the middle and pulling each half forward and laterally. This can be most effective for patients with scarring on the sides of the throat that can occur after a tonsillectomy or other previous soft palate procedures. 

Z-palatoplasty tends to be associated with more difficulty swallowing post-surgery compared to other palate procedures, but it can be necessary and important for certain patients.

Relocation Pharyngoplasty

Relocation Pharyngoplasty includes sewing together the muscles on the side of the throat to open the space for breathing. This surgery for sleep apnea requires very little tissue removal.

With so many palate surgery options available, it can be overwhelming to know which one may work for you. Each case of sleep apnea can vary, so getting a proper diagnosis is the most important step. Consult with your doctor to decide which treatment for sleep apnea is best for you.


By Dr. Eric Kezirian

Philips Better Sleep Program

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One comment on “Palate Procedures for Obstructive Sleep Apnea”

  1. How do I locate physicians who specialize in soft palate procedures to determine whether surgery might be a suitable option for me?

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