Uvulopalatopharyngoplasty (UPPP)

Clinical Indicators
Uvulopalatopharyngoplasty (UPPP)

Procedure	CPT	FUD
Uvulopalatopharyngoplasty	42145	90
Uvulectomy	42140	90

Indications
1. History... one or more required

a)	Snoring--disruptive.
b)	Restless sleep due to breathing difficulty.
c)	Daytime sleepiness.
d)	Witnessed apnea or gasping during sleep.
e)	Cardiac arrhythmias related to upper airway obstruction.

2. Physical Examination...all required

a)	Examination by any method including fiberoptic endoscopy and Muller maneuver of nasal, nasopharyngeal, oral, oropharyngeal, hypopharyngeal, and laryngeal airway.
b)	Description of oropharyngeal obstruction as most likely cause of obstruction.
c)	Describe breathing quiet, noisy, wheezing, expiratory or inspiratory stridor, etc.

3. Tests

a)	Polysomnography--recommended for apnea diagnosis.
b)	Cephalometrics--optional.
c)	Sleep endoscopy--optional.

Postoperative Observations

1.	Airway--breathing should be quiet and unobstructed. If noisy, look for palate edema. Notify surgeon.
2.	Bleeding--blood-streaked sputum is normal. If bleeding from mouth, nose, or vomiting fresh blood, notify surgeon.
3.	Oximetry--if abnormal, notify surgeon.
4.	Swallowing--maintain hydration by IV and do not discharge patient until oral intake is adequate. If medication for pain is required, look for respiratory depression.

Outcome Review
1. One Week

a)	Healing--Is wound closure intact? Did patient require treatment for bleeding?

2.Beyond One Month

a)	Symptoms--Does polysomnography show improvement? Has there been improvement in the presenting complaint? Is further treatment necessary?

Associated ICD-9 Diagnostic Codes

786.09	Snoring;
780.51	Insomnia with sleep apnea
780.53	Hypersomnia with sleep apnea

Additional Information
Assistant Surgeon -- N
Supply Charges -- N
Prior Approval -- N

Anesthesia Code(s)
00160

Patient Information

Uvulopalatopharyngoplasty (UPPP) is an operation to improve certain sleep disorder symptoms such as obstructive sleep apnea and snoring. Because there may be several causes occurring at the same time, this procedure may only give partial relief depending on the relative importance of palate and uvula size. The success rate in treating apnea cases has been reported to be greater than 50%, and the expectation for snoring improvement may be greater than 80%. The most common complications include bleeding after surgery, infection, and temporary airway obstruction due to post operative swelling. Occasionally patients with severe obstruction or added risk due to obesity may require a temporary tracheostomy. Some patients also have complaints due to an inability of a shortened palate to make contact with the back of the throat. This may cause some nasal regurgitation and a hyponasal or hollow-sounding voice. The opposite effect due to narrowing of the space behind the nose (nasopharynx) is even less likely. As a general rule, the more carefully patients with sleep disorders are studied and selected, the greater the likelihood of improvement after UPPP.

Important Notice
The Clinical Indicators for Otolaryngology--Head and Neck Surgery are guidelines only. In no sense do they represent a standard of care. The applicability of an indicator for a procedure, and/or of the process or outcome criteria, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these guidelines will not ensure successful treatment in every situation. The American Academy of Otolaryngology-Head and Neck Surgery, Inc. emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.