ABSTRACT
Uvulopalatopharyngoplasty (UPPP) has been the most commonly used surgical procedure for the treatment of obstructive sleep apnea (OSA) and related snoring since its introduction by Fujita et al. (1) in 1981. It also has the distinction of being one of the longest names for a surgical procedure. Unfortunately, because of limitations in our ability to clinically diagnose the site(s) of obstruction in a given case of OSA, its success has been sub-optimal with regard to significant improvement in the apnea index (AI) or respiratory distress index (RDI). This is because this procedure was designed to open the airway at the level of the soft palate and retropalatal oropharynx; we now know that in the majority of cases the obstruction is also at the level of the base of the tongue and retrolingual hypopharynx. Fujita (2) later introduced a staging system to clarify the role of UPPP: type I-collapse during sleep occurs at the retropalatal level; type II-collapse at both the retropalatal and retrolingual areas; and type III-collapse at only the retrolingual area. The UPPP would be expected to be successful in most type I cases and in a certain percentage of type II cases and unsuccessful in type III cases. Since the majority of OSA cases are thought to be type II (60%) with about 20% each in types I and III, a success rate of around 50% would be expected, assuming that half of the type II cases have obstruction predominantly at the retropalatal level.
