What are the differences and recommendations for Cheiloplasty (cheiloplasty), Uvuloplasty (uvuloplasty), and Palatoplasty (palatoplasty)?

Differences and Recommendations for Cheiloplasty, Uvuloplasty, and Palatoplasty

Cheiloplasty should be performed for cleft lip repair, palatoplasty for cleft palate repair, while uvuloplasty is not recommended for obstructive sleep apnea (OSA) treatment due to lack of demonstrated efficacy in improving clinical outcomes.

Cheiloplasty (Lip Repair)

• Cheiloplasty is a surgical procedure specifically designed for the repair of cleft lips in both children and adults 1
• Primary techniques include rotation advancement with small triangular flap method or straight method with triangular flap for unilateral clefts, and one-stage repair method for bilateral clefts 1
• In adult patients with untreated cleft lips, more aggressive correction is possible as maxillary growth is no longer a consideration 1
• Correction of the anterior nasal deformity is more challenging in adults due to decreased tissue elasticity and more severe deformity of the nasal cartilages 1
• Cheiloplasty can be performed under local anesthesia in adults to reduce cost, time, and required medical personnel 1

Uvuloplasty (Uvula Surgery)

• Uvuloplasty procedures include laser-assisted uvulopalatoplasty (LAUP) and traditional uvulectomy, primarily targeting the uvula and soft palate 2
• The European Respiratory Society explicitly recommends against uvuloplasty for OSA treatment due to lack of demonstrated efficacy (negative recommendation B) 2, 3
• LAUP has not demonstrated significant effects on OSA severity, symptoms, or quality of life domains 3, 2
• In mild OSA, LAUP failed to show clinically relevant improvement in respiratory parameters (only 21% reduction in AHI from 19 to 15 events/hour) with no improvement in subjective sleepiness or quality of life 3
• Potential complications of uvuloplasty include post-operative airway compromise due to edema, velopharyngeal insufficiency, dry throat, and abnormal swallowing 3

Palatoplasty (Palate Repair)

• Palatoplasty encompasses various surgical techniques for cleft palate repair and is recommended to be performed between 6-12 months of age 4
• Hard palate repair techniques include Veau-Wardill-Kilner V-Y, von Langenbeck, two-flap, alveolar extension palatoplasty, and vomer flap 4
• Soft palate repair techniques include intravelar veloplasty, double opposing Z-plasty, and radical muscle dissection 4
• The ideal palatoplasty technique should provide optimal speech outcomes without negatively affecting maxillofacial growth or hearing 4
• For OSA treatment, uvulopalatopharyngoplasty (UPPP) is a form of palatoplasty that can only be recommended in carefully selected patients with obstruction limited to the oropharyngeal area (Grade C recommendation) 3

Comparative Effectiveness in OSA Treatment

• UPPP has shown approximately 50-69% success rates when defined as >50% reduction in respiratory disturbance index in carefully selected patients 5, 6
• Modified techniques like Han's UPPP (H-UPPP) with uvula preservation have reported 69.12% success rates with fewer complications compared to classic UPPP 6
• LAUP and UPPP have shown comparable response rates (47.4% vs 51.2%) in some studies, though UPPP demonstrated greater improvement in oxygen saturation levels 7
• Multi-level surgery may be considered as a salvage procedure for OSA patients in whom CPAP and other conservative therapies have failed 2
• Surgical success rates for isolated soft palate procedures are generally poor (approximately 50%) and even lower in patients with multi-level obstruction 2

Important Considerations and Recommendations

• For OSA treatment, CPAP remains the standard treatment, and all attempts at improving effectiveness and adherence should be undertaken prior to considering surgical interventions 3
• Surgical procedures may be considered as secondary treatment for OSA when PAP therapy is inadequate due to patient intolerance or inability to eliminate OSA 3
• Patients with retropalatal and retrolingual collapse have only a 5% success rate with isolated palatal procedures, emphasizing the importance of proper patient selection 2
• Serious life-threatening complications of UPPP include intubation difficulties, bleeding, and acute upper airway obstruction (1.5% incidence) with a mortality rate of 0.2% 3
• Long-term side effects persist after UPPP in 58% of patients, including swallowing difficulties, globus sensation, voice changes, and nasopharyngeal stenosis 3