Palatal Reconstruction (Pasha Modification)

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Dr. Pasha has developed his own unique approach to reconstructing the back of the throat to treat sleep apnea. He essentially has modified an older technique called a Uvulopalatopharyngoplasty or UP3 and improved the method, which he believes reduces the side effects and improves outcomes. His version is much more minimal to better preserve function. After performing over 1,600 procedures to treat snorers and sleep apneic patients, Dr. Pasha believes that palatal reconstruction is a much-improved method than traditional approaches. He describes the procedure as a “face lift” for the back of the throat.

Remember the soft palate is the back of the roof of the mouth, which is soft. The “bell” that attaches to the soft palate is called the uvula. The tonsils are the two balls on the sides of the back of the throat and are surrounded by a pocket. The soft palate, uvula, tonsils, and tonsil pocket all make up the snoring center where the sound of snoring originates. When elongated, this is also the area that flaps backward when you sleep, blocking your airway causing apneas.

Dr. Pasha’s modification on Palatal Reconstruction involves several steps:

  1. Removal of the Tonsils and the Tonsil Pocket: By removing the tonsils (standard tonsillectomy) as well as the tonsil pockets, the sides of the throat are widened. This step may also be performed in people who have already had their tonsils removed (but not removal of the tonsil pocket). Adenoids, which are located behind the nose, may also be removed at the same time.
  2. Reconstruction of the Sides of the Throat: After removal of the tonsils and tonsil pockets there is an open space. This space is closed in a way to allow for proper healing.
  3. Removal of part of the Soft Palate: The floppy area of the back of the throat is then removed while preserving as much of the mid-portion and muscle to preserve the function of swallowing and speaking.
  4. Reconstruction of the Soft Palate: The soft palate is then reconstructed in such a way to allow for healing a preservation of function.
  5. Reconstruction of the Uvula (Uvuloplasty): Dr. Pasha believes that everything in the body has a purpose including the uvula. According to Dr. Pasha, he believes that the uvula has several functions including “funneling” secretions from the nose down the center of the palate so that you unknowingly swallow it. The uvula may also serve in roles in swallowing and speech.

The last step is that Dr. Pasha will either shorten the uvula or create a “new” uvula using tissue from the soft palate.

FAQ

For the majority of cases, palatal reconstruction may be performed within one hour. During this time, family and friends may stay in the waiting room. After the case, one typically spends one hour in the recovery room. Typically, family and friends may see the patient after a couple of hours.

Dr. Pasha believes that everything in the human body has a purpose. The soft palate prevents food and drink from entering your nose when you swallow and also functions during speech. Dr. Pasha believes that the uvula also serves in the roles of swallowing and speech but also has a unique function as a “funnel” for nasal secretions. Everyone produces nasal secretions that drip into the back of the throat without you realizing it. You naturally swallow these secretions. The uvula helps direct the secretions by centering the drip as it goes down the soft palate to the esophagus (swallowing tube).

Dr. Pasha’s modification and reconstruction technique helps preserve these functions by re-creating what was removed.

The tonsils are lymphatic organs than help fight infection in their normal state. If they become too big they tend to instead harbor a constant infection causing repeated tonsillitis or sore throats. Removal of the tonsils has been shown time and time again to have no risk in increasing infections. In fact, by removing your tonsils you may have a decrease in throat infections.

The recovery from a palatal procedure varies. You will have a sore throat for 7-10 days and the discomfort may last 2-3 weeks. Often you may be referred to a pain specialist and given medication to control the discomfort.

You will be on a soft diet for 2 weeks and you should anticipate a 5-15 pound weight loss from being on a liquid and soft diet. Immediately afterward, it will feel strange to swallow as your anatomy has completely changed. Your first swallows will feel awkward. You may be required to stay overnight and should anticipate missing 7-10 days of work.

Before you leave the hospital or surgery center, the nurses will make sure you are able to tolerate soft foods. You should continue with a soft diet (e.g., sherbet, popsicles, ice cream, or juices) for 1-2 weeks and avoid foods that are hard, hot, spicy, or sour. Acidic or citrus products such as orange juice can also be irritating. Dairy products are acceptable.

Ear Pain: Often you may have ear pain. This pain is typically not from your ears but from your throat. The same nerve that innervates (connects to) your throat also innervates your ear.

Fever: Low-grade fevers (<100.5º F) are acceptable after surgery.

Bad Breath: After surgery, the tonsil areas will be covered with a white covering called an exudate, which sometimes causes bad breath for up to 14 days.

Change in Voice: If your tonsils are very large, speech may become different after the operation. This may be temporary and reverts to your normal voice after the swelling resolves.

Continued Snoring: Even after the procedure, you may still have snoring immediately following the operation. This should resolve after the swelling is reduced.

Generally speaking, tonsillectomies and palatal operations are common, safe procedures that rarely result in serious complications.

The most common complication is bleeding. During the procedure there is generally little bleeding. The odds of returning to the operating room after the procedure because of bleeding are 1:100. The first risk occurs within the first 24 hours of surgery. The second risk occurs 7-21 days later when the white scab that covers the wound may become dislodged.

As with any sleep apnea procedure failure is a possibility, as no guarantee can be made for any snoring/sleep apnea procedure. A more comprehensive list of potential complications will be discussed in the office.

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