Do NOT have a UPPP (Uvulopalatopharyngoplasty). Here's why...

[@samh6761]

The illustrations and visual aids in your videos are top notch. I learn so much from these.

[@VikVeerENTSurgeon]

I'm glad they helped - thank you.

[@allentig]

It worked for me, and time it works better.

[@yomi001]

You're scaring me. I had my UPPP surgery 15 months ago. My surgeon never said these sort of complications could occur later on. I think this surgery is still commonly done here in Canada. It only barely improved my sleep quality. I hope I won't be even worse off in a few years. Is there anything I can do to reduce my chances of getting scar contraction that hinders my breathing? Like maybe throat exercises? Thank you for your help. I really appreciate these informative videos.

[@VikVeerENTSurgeon]

If your sleep study has not improved much, I would go back and explain the situation with your sleep department. there are so many new options available now.

[@JonathanSundqvist]

​@@VikVeerENTSurgeonWould be interesting to hear what other options are available now

[@linoslaw-thelawofficeoflino]

@@JonathanSundqvist I would like to know what other options are available as I have had 2 doctors also tell me to get UPPP surgery because I don't qualify for Insipre because I have too many OSAs.

[@SajidKhan-kt6rz]

@@JonathanSundqvist Go for double jaw surgery

[@catallergiccat]

@@SajidKhan-kt6rz Gosh, that is a very scary painful option.

[@tren380]

What other options are available now?

[@RyanWilliams222]

Wow, great information! I’ve had a couple of surgeries for sleep apnea including (1) expansion sphincter pharyngoplasty + tonsillectomy (palatine and lingual), and (2) palatal advancement. Two questions: 1) Do people ever travel from the US to get an evaluation / have surgery with you? 2) What are your thoughts on maxillomandibular advancement (MMA) surgery?

[@VikVeerENTSurgeon]

it's probably a lot cheaper to stay in the USA and NHS is only for UK residents. MMA video is here - kzbin.info/www/bejne/l3vChJiipbqobLM

[@lorenzoishere]

Dude i´ve had 10 years ago a PPP and 1 year ago a MMA, no improve.

[@SajidKhan-kt6rz]

In my opinion, MMA has higher success rate

[@RyanWilliams222]

@@lorenzoishere I’m really sorry to hear that! What was the nature of your problem? And did they give you any explanation regarding why the MMA surgery didn’t help?

[@CynthiaSalinas-ce2jf]

@@RyanWilliams222 Hello, did those surgeries work for you?

[@_anyone5962]

Thank you very much for the explanation Doc. No wonder my friend said his surgery did not work after one year. Is the next episode about what should be done on some very serious sleep apnea?

[@VikVeerENTSurgeon]

Thanks for the comment. The key is to do a DISE and then to work out what operation would work best for each patient. I have a few videos about DISE on my channel. I'll do a video on ESP and Barbed soon which are the closest operations to UPPP as they work on the lateral wall.

[@Rohitbhardwaj39]

Any update video on nightlase do you recommend sessions using that ?

[@VikVeerENTSurgeon]

I have an email series on that which explains it completely.

[@rickcunliffe7072]

My ENT through the NHS scoped me to assess which areas of my throat/soft palate were potentially responsible for my snoring. All he asked me to do was make a snoring sound and then immediately suggested removing my Uvula. Quelle surprise, I still snore. Not sure if it was a rushed decision on his behalf.

[@VikVeerENTSurgeon]

I'm really sorry. I am trying to spread the word. it's my mission to make this a thing of the past. so sorry.

[@alexanderdean5793]

Hey Vik, are you still planning on releasing the "Why BIPAP doesn't treat UARS" video?

[@VikVeerENTSurgeon]

UARS is quite an emotive subject and I get quite a lot of hate mail about it. I am going to avoid UARS for the time being, sorry.

[@alexanderdean5793]

@@VikVeerENTSurgeon Is there any chance you could still link me the evidence that BIPAP doesn't work for UARS? I'd be really interested to know why, especially as I'm struggling to get results from BIPAP.

[@blazejp0601]

I cancelled a surgery that would involve two procedures: laser-assisted UPPP and palate radio frequency. I can't really understand why the ENT insisted that a patient would ever need both - if he cuts off the soft palate, why the need for additional palate radiofrequency procedure???

[@VikVeerENTSurgeon]

well in his defence, it might make sense if your surgeon was doing a limited LAUP (redundant tissue only), and then RFA to the palate. it would mean reduced pain and it would probably work if you are only a snorer with no sleep apnoea and if your retropalatal distance was good. I don't know the details of your case but I would speak to your surgeon. Bhik Kotecha has the biggest case series of these.

[@chris_jorge]

:( just had uppp 6 weeks ago. i wish i would have seen this vid earlier.l my tonsils were almost touching so that's why i went in. doc did what looks to be minimal uppp since i still have a very visible uvula. i snore less but def not cured. looking at a MAD hoping that gets me over the hump ty!

[@VikVeerENTSurgeon]

if your tonsils have been removed, then i'm sure that will help matters. the snoring is not a good indicator of your sleep apnoea. often when the sleep apnoea gets better the snoring gets louder - More air passing - more vibrations etc.

[@discontinuity7526]

Dang, I just had a UPPP, epiglottis stiffening, tongue base reduction 4 weeks ago. I'm completely healed now, but my oximeter shows pretty large oxygen drops during REM still, and smaller drops during deep sleep. I'm not sure exactly what kind of UPPP he did, mine looks a little different than in the video. I have my follow up with him in 3 days.

[@VikVeerENTSurgeon]

Tongue base reduction often takes several months (3-6 months), before you notice the improvement (depending how they reduced it). there are lots of good modifications of the UPPP to make it better and safer. I would wait and see what the sleep study shows in about 6-9 months before worrying about it. REM drops are quite common at this stage.

[@Idyllll]

Was it a uvulopalatal flap?

[@jennygibbons1258]

This was the most excruciatingly painful operation to absolutely no avail. The agony lasted a long time and I couldn’t even bear to swallow my own saliva for the pain caused. Snoring worse than ever now!!

[@VikVeerENTSurgeon]

speak to your surgeon and perhaps get a DISE to see what is going on in there?

[@jennygibbons1258]

Thanks for your reply; I appreciate it.

[@VikVeerENTSurgeon]

out of interest, who classified that for you. They are using my classification and I like to know everyone who does. it helps me to find out if they have any issues using it. CCC L2 = barbed would be a good option.

[@dasssakthivel5260]

Hi doc.. will you pls tell me what are the other options for sleep apnea

[@lesptitsoiseaux]

Could you do a video on barbed pharyngoplasty?

[@VikVeerENTSurgeon]

I'm editing something to do with barbed now.

[@lesptitsoiseaux]

@@VikVeerENTSurgeon Thank you so much! :) I have CCC L2 and I'm told it could help!

[@HappinessPrisca]

Please Does this surgery affect speech?

[@nodeonecreations]

I had a septoplasty in early December. Two weeks after I had a sleep study at home. I was still mouth breathing. Apparently the AHI came back as 20. Would you question the reliability of the home sleep study test in this situation Mr Veer? I did try to explain to the sleep assistant before taking it home.

[@VikVeerENTSurgeon]

It is likely to show improved results if you do the sleep study again in about 2 months when you are able to breathe better. sorry.

[@lorenzoishere]

How does that soft palate ends after a maxilo mandibular advancement,? no palate to drop onto the tongue?

[@VikVeerENTSurgeon]

the palate is pulled forward in MMA

[@weareallmadeofstars6814]

I had a uppp and some other things done 5 years ago, am supposed to go back to recheck it soon and the nurse told me that most go back as to before and surgery do not work as intented. I am part of a bigger study on this and should have gone back sooner but the pandemic postphoned it. Is there anything I could take with me to the surgeons and hospital? I also recently bought a cpap-apap to try again (couldnt manage it before since deviated septum but now that is corrected and healed). And I hope c-pap will work eventhough you say it might not (pressure settings could be important?). Would greatly appreciate some advice for me to take with me to them before going there again. Also thanks for all your contributions and heartfelt work, it means a lot to many of us!

[@VikVeerENTSurgeon]

it is only if they have removed too much palate that CPAP would not work. I would try it and speak to the research nurse about your results in the trial.

[@weareallmadeofstars6814]

@@VikVeerENTSurgeon Interesting, I still after that surgery have my nasal voice and that do correlate with the soft palate I think!? and also had scar tissue removed afterwards. But then I know what to adress. When I tried cpap now (not a good model though hence waiting for the new one) it feels totally different with mouth closed or if I open moth where I can feel all air going through mouth instead. Guess I migh have to go for lord voldermort style then. Thanks for quick reply, much appreciated!

[@smooth_pursuit]

Dr Veer, do you have any opinion on the iQoro device, used to train and strengthen the esophageal muscles? I believe this is now available on the NHS

[@VikVeerENTSurgeon]

I'm not a fan, but it does help a bit. If you are interested I would speak to a myofunctional therapist.

[@smooth_pursuit]

@@VikVeerENTSurgeon thank you

[@Idyllll]

Hello, I had a uvulopalatal flap done 10 days ago. Unfortunately it's still hanging low that it touches my tongue when my mouth is closed. Also, I have a flap of tissue on my right side whereas none on my left side. I was wondering when should I consider a revision? I'm interested in seeing you for it and was wondering if you do revision surgery and how soon after the initial surgery?

[@VikVeerENTSurgeon]

it is nearly always swollen after surgery. I would wait a minimum of 6 months. I'm sure your surgeon has done a good job. speak to them at 6 months if it isn't working for you - get a sleep study as well.

[@Idyllll]

@@VikVeerENTSurgeon Thank you

[@hannibalthe1st565]

I had surgery on my hard palate to remove part of the excess bone so i can fit a dental device called VIVOS that will expand my palate both length and width. However, some of the skin was destroyed and my doctor pulled some of the soft palate over the back of the hard palate. This brought my uvula forward into and obstructive position along with thicker soft palate tissue that now mixes with my uvula and obstructs my airway. What should I do? Please help, this has made my sleep apnea so much worse!

[@johnwayne397]

so are you saying the modified versions will work aparently theres multiple versions, my tonsils need out regardless there a 3 and 4, this is scaring me

[@johnwayne397]

ok im looking at the my chart, the nurse said im doing a up3, but the chart says palatoplasty....bovie 20/20 bipolar 20, i looked up palatoplasty and it says its a combination of removing and repositiong and its different than the vuvulop..... the longer word where u just remove possibly more, so would the palatoplasty be better, cause i did tell her in the first meeting im scared of the food part but i didnt know about the collapsing years later thng, she said, we dont have to remove all of it, but if the nirse said up3 isnt that different than palatoplasty...and also did you say that they should just cut out the dropping loose tissue and do not cut to deep into the muscles?

[@catallergiccat]

I had a so called conservative modified UPPP or just creating some little wounds on the soft palate in order to tighten it a little bit. But 4 months later, my mouth leaking is even worse, my CPAP therapy is compromised .. which means I cannot reach to desired pressure (I couldn't in the past either), and very prone to CPAP-gas (bloating, aerophagia). Now, what can I do about it? @Vik Veer, can you please advise?

[@maxaffe3195]

i am so sorry what happened to you

[@synthiasita259]

What type of modification did they use?

[@jeremymarchand46]

So i had a UPPP to pull the soft palate forward and sublingual tonsillectomy and they also took out my tonsils what should i do

[@VikVeerENTSurgeon]

I would have a DISE and find out why you have sleep apnoea. see my videos for more details

[@jeremymarchand46]

​@@VikVeerENTSurgeonhi d. Veer I had a drug induced sleep endoscopy and that when my dr. His name was dr. Zaghi is there any way I can get in touch with you dr. Veer I would greatly appreciate your thoughts and help it possible