Lateral pharyngoplasty is performed under general anesthesia in the operating
room to treat obstructive sleep apnea. This procedure is combined with
tonsillectomy and involves a combination of tissue removal and tissue
repositioning of the soft palate (roof of the mouth) as well as the lateral
pharyngeal tissues (side of the throat). The goal of the procedure is
to increase the size of the airway without affecting normal functions
such as breathing, speaking, and swallowing. Lateral pharyngoplasty appears
to offer advantages for some patients with obstructive sleep apnea compared
to traditional palate procedures.
For more information about the selection of palate procedures, please see
your doctor about choosing the best palate surgery for snoring and sleep apnea.
View of the mouth before palate surgery
View of the mouth during lateral pharyngoplasty, stage 1
View of the mouth during lateral pharyngoplasty, stage 2
Lateral pharyngoplasty, which includes tonsillectomy, carries a risk of
bleeding. A major factor in preventing serious bleeding is to avoid the
use of aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen,
or Aleve®), vitamin supplements, or herbal medications for at least
two weeks before and after surgery. Approximately 2-4% patients who undergo
lateral pharyngoplasty experience bleeding after surgery. Half of these
patients require an additional procedure—either in the outpatient
clinic or the operating room—to control their bleeding. Please notify
your surgeon immediately if you have bleeding of a teaspoon or more. If
the bleeding is significant, immediately seek care in the closest emergency
department or call 911.
Infection is rare but not impossible after lateral pharyngoplasty. Patients
typically receive antibiotics at the time of surgery to reduce the chance
of infection and decrease swelling. Patients should not use mouthwashes
following surgery because many of these contain alcohol that can irritate
the lining of the mouth and interfere with healing.
The palate and sides of the throat are important in swallowing. After lateral
pharyngoplasty, patients may experience two kinds of difficulties with
swallowing. Many patients have liquids or food come up in the back of
the nose or occasionally through the nose because the soft palate is not
performing its normal function to separate the back of the mouth from
the back of the nose. This happens in many patients for a brief period
(1-2 days) due to swelling in the area, but it is unusual for this complication
to be permanent and significant. The second kind of difficulty with swallowing
is that liquids or food may go “down the wrong way” towards
the lungs, resulting in coughing as an attempt to clear the material.
This can occur due to swelling and repositioning of the muscles in the
sides of the throat but is usually temporary. It can occur for a more
prolonged period if some nerves in the sides of the throat are damaged,
but it is rare for this to be permanent.
Changes in speech
Any operation on the palate and sides of the throat can cause changes in
speech, but these changes are rarely permanent.
Narrowing at the top of the throat
Rarely, lateral pharyngoplasty will result in narrowing behind the palate—which
is also the top of the throat. This complication can make breathing through
the nose difficult as well as create problems with speaking and swallowing.
Additional surgery may be necessary to correct this problem.
Operating in the back of the throat is impossible unless an instrument
is placed to keep the mouth open. This is the same instrument used when
tonsillectomies are done. Rarely, a tooth may be injured by this instrument,
and the risk is much higher if a tooth is loose or decayed prior to surgery.
Most patients undergoing lateral pharyngoplasty will also have loud snoring.
The goal of surgery is to eliminate obstructive sleep apnea. Usually snoring
will improve dramatically if this goal is accomplished. However, many
patients will continue to snore to some extent, even after surgery that
resolves obstructive sleep apnea completely.
You should be prescribed narcotic pain medication after surgery. Take this
medication as you need it for pain control, and try not to let the pain
increase until it becomes intolerable before you take the medication.
If you are running out of medication and need more, please call the office
in advance to obtain another prescription. If you prefer to avoid narcotics,
you should feel free to use acetaminophen (Tylenol®). Avoid aspirin,
NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®),
vitamin supplements, or herbal medications for at least two weeks because
they can increase your risk of bleeding after surgery. Your pain will
be significant for at least the first 7-10 days following surgery, but
it should improve markedly by 14 days following surgery.
Due to the pain and swelling that is to be expected, you will most likely
only be able to tolerate a liquid diet for the first 4-5 days after surgery.
Push yourself to increase your intake of fluids and avoid dehydration,
and you can monitor this by checking to see that you are voiding (urinating)
frequently enough. It is helpful to drink liquids in addition to water
(such as juices or Gatorade® and, especially, milk shakes or Ensure®)
to provide energy and protein during the recovery period. After this period
of time, you should transition to soft solid foods such as eggs or yogurt.
You should be able to tolerate a largely normal diet by 14 days following
surgery. During this period of recovery, you should avoid foods with sharp
edges such as chips because these can cause bleeding. Otherwise, you can
advance your diet according to your own schedule, being careful not to
cause too much pain.
You may be prescribed an antibiotic to take for several days. This can
be useful for preventing infection and decreasing swelling. Take the antibiotics
as directed. If you develop a rash or diarrhea (possible risks of antibiotics
and other medications), stop the antibiotics and contact your doctor immediately.
Minimize strenuous physical activity for four weeks
At a minimum, patients should walk at least three times a day starting
the day after surgery. Walking and spending more time out of bed (walking
or in a chair) rather than in bed are helpful because they reduce the
risks of developing pneumonia or blood clots in the legs. However, patients
should avoid strenuous activity because that typically raises heart rate
and blood pressure. For this reason, it can increase swelling or cause
bleeding to start.
Jaw discomfort or ear problems
The swelling in your throat that occurs after surgery can cause jaw pain
or ear symptoms such as pain, pressure, or fullness. This is common and
should improve within 1-2 weeks following surgery. It occurs because the
soft palate and tonsils are next to the jaw and the small Eustachian tube
that connects the space behind the eardrum to the top of the throat. Swelling
in the throat can interfere with your ability to clear or pop your ears,
and it can also be sensed by your body as pain coming from your ears even
though the ears are not affected (a phenomenon called referred pain).
Sleep with head elevated (at 45 degrees) for at least three days
Elevating your head during sleep decreases blood flow to the head and neck
regions. Therefore, it decreases swelling and the associated pain. Elevating
the head during sleep may also improve breathing patterns in other ways.
Therefore, we recommend elevating your head during sleep at 45 degrees
for at least three days following the procedure.
NOTIFY YOUR DOCTOR IMMEDIATELY IF YOU HAVE ANY TROUBLE BREATHING OR IF
ANY BLEEDING DEVELOPS!