ABSTRACT
CAPSO is a 10-min surgical procedure performed in the otolaryngology clinic with the patient sitting in the examination chair. The soft palate is examined with the mouth comfortably open (Fig. 1a). Topical anesthesia is first administered with 14% benzocaine (Cetylite Inc., Pennsauken, NJ) oral spray (Fig. 1b) followed by a benzocaine gel ‘‘lollipop’’ (200 mg/g gel; Henry Schein, Port Washington, NY) applied on the end of a tongue depressor. The ‘‘lollipop’’ is held against the soft palate for 5minutes. Next, a 27-gauge needle is used to inject 5mL of 2% lidocaine with 1:100,000 units of epinephrine submucosally in the midline soft palate extending 1 cm laterally on each side (Fig. 1c). The cautery is set to a blend of cut and coagulate (‘‘Blend 3’’ on Valleylab electrosurgical generator, Boulder, CO). This mode provides optimal hemostasis while minimizing excessive postoperative pain and thermal injury. A tonsil suction evacuates cautery smoke. A sheathed needle-tip cautery outlines an inverted ‘‘U’’ on the soft palate. The outlined points are then connected with the cautery (Fig. 1d). A 2-cm strip of midline soft palate mucosa is developed staying 1 cm distal to the hard/soft palate junction (Fig. 1e). The mucosal strip is peeled off the palatopharyngeal muscle toward the uvula. The uvula is lifted (Fig. 1f) and the mucosal uvulae are dissected off the muscular uvulae (Fig. 1g). The wound is left to heal by secondary intention (Fig. 1h). The patient is observed after the procedure for 10min and then sent home. Resected palatal mucosa may be examined by means of routine histology. One month after the procedure, a midline palpable scar is noted and the palatal snoring is successfully treated (Fig. 1i).
