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Article Type

Article

Abstract

Background and Objectives: Recently by improvement of the education levels of general populations the snoring has been considered as one of common presented problems at otorhinolaryngeology departments which may interfere with normal personal social life thus the research for optimum procedures to resolve this problem become one of the priorities at this specialty.

Although snoring can be due to functional predisposition but still the obstructive verity of snoring is commonest. This obstruction can occur at different levels starting from nose up to oropharynx with variable degrees of obstruction severity. The uvula is considered as one of the common structures of upper air way tract which may develop certain anatomical abnormalities resulting in upper air way obstruction. In the same time it is claimed that interference with the uvula by recommended procedures including CO2 laser surgical procedures may effectively help in management of this problem.

Therefore this study was conducted prospectively to assess whether there is any significant difference between these variable uvular related laser procedures from the outcomes point of view regarding relief of snoring as well as from the postoperative complications point of view.

Patients and Methods: Thirty - six patients aged 23-55 years presented at ENT department –Althowra central hospital – elbyda – Libya with history of snoring which disturbs the normal social life of those patients and through the local clinical examination there were four varieties of local uvular related findings via which the received patients were divided into four groups, in group-A the patients underwent laser uvulopalatopharyngoplasty (LUPPP), group –B patients operated by laser assistant uvuloplasty (LAUP), while at group-C patients proceeded by what is called laser uvular flap procedure (LUFP), and the last group was group-D in which patients were interfered by the modified laser uvular flap procedure (MLUFP). All patients were evaluated preoperatively by modified sleep study, thyroid function test, chest imaging, ECG, body-mass index measurements as well as all routine blood tests. In addition all patients were followed up for six months postoperatively to confirm the degree of improvement in snoring and to elucidate for any post procedure complications development.

Results: Regarding the snoring, all patients at all four groups showed significant postoperative improvement in snoring. 80% of patients at group-A showed non-significant intra operative and postoperative bleeding, non-significant postoperative dysphagia, odynophagia, referred otalgia, fever, and vomiting tendency as compared to other three groups where all patients showed same results. All patients of group-A stayed more than 24 hours postoperatively at hospital as compared to group-B in which 60% of patients stayed less than 24 hours at the hospital after surgery while 65% of patients in both group-C and D who showed same results. On the other hand 15% of patients in group-A developed postoperative foreign body sensation and nasal regugatation as compared to other groups at which no patient was presented with this kind of complications. One patient of group-A was presented with recurrence of snoring after three years from the surgery. Regarding otitis media, airway obstruction and septicemia, in all four groups no cases were registered. The healing process as sequel of all procedures completed by one week.

Conclusion: Generally speaking uvula constitutes one of important anatomical structures at upper air way tract which plays very significant role in pathogenesis as well as management of snoring. There are different varieties of laser surgical procedures which can be used to treat uvular related snoring. The selection of the proper procedure is depending up on many local as well as systemic factors. The proper selection of optimum procedure will determine the degree of intervention succeeds.

Keywords: Snoring, CO2 laser uvulopalatopharyngoplasty, CO2 laser assistant uvuloplasty, CO2 laser uvular flap procedure, CO2 modified laser uvular flap procedure.

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