UPPP

UPF

LP

AP

ESP

RP

Roman Blinds

Bilateral tonsillectomy with trimming and resection of excess pharyngeal mucosa. Arch shaped incisions are then made on either side of the uvula followed by blunt dissection to remove the fat from the spatium veli palate. The free palatal mucosa is then sutured together and the anterior and posterior pillars are sutured together

The Uvula is reflected upwards on the palate and an outline is marked. A diamond shaped segment of mucosa and submucosa starting from the outline downwards is removed in addition to the anterior aspect of the uvular mucosa. The uvular tip is shortened. Finally, the uvula is then reflected onto the soft palate and sutured into place

The technique entails performing a tonsillectomy. If the patient had previously undergone a tonsillectomy, then a vertical myotomy is done in the tonsillar bed in order to access the Superior Pharyngeal Constrictor (SPC) muscle. The SPC Is then vertically sectioned resulting in two flaps, the lateral of which is sutured to the anterior pillar on the same side. A half thickness incision is made in the oral aspect of the soft palate extending supero-laterally from the base of the uvula to the lateral soft palate margin. The Palatopharyngeus muscle is sectioned transversely. Z plasty is used to suture the upper palatopharyngeal muscle flap with the palatine flap created previously. The lower palatopharyngeal muscle flap is then sutured to the anterior pillar on the same side. The same steps are repeated on the opposite side.

A rectangular strip of mucosa midway between the hard palate and the uvula is removed down to the muscle layer without removing any of the muscles. The skin edges are then approximated thus bringing the soft palate antero-superiorly. Partial uvulectomy may be done if needed

Tonsillectomy followed by identification and horizontal transection of the Palatopharyngeus muscle near its inferior end. A superolateral incision is made extending from the base of the uvula to the soft palate margin, in order to uncover the arching palatoglossal fibers of the soft palate. A suture is taken through the bulk of the Palatopharyngeus muscle and attached to the arching palatoglossal fibers. The anterior and posterior pillars are then sutured together. The same steps are repeated on the opposite side. Partial Uvulectomy for patients with enlarged uvula.

Tonsillectomy is the first step followed by bilateral incisions extending from the base of the uvula supero-laterally to a point (near the pterygoid hamulus) and then from there downwards to connect to the base of the anterior pillar.

The mucosa, submucosa and adipose tissue in the superolateral corner of the palate bounded by the incisions made previously is dissected.

The Palatopharyngeus (PPM) muscle near the uvula is rotated supero-laterally to be sutured to the area previously dissected. The medial aspect of the Superior Pharyngeal Constrictor muscle (SPC) is sutured to the ipsilateral Palatoglossus (PGM) muscle thus splinting the SPC to the ipsilateral tonsillar fossa. The remaining PPM is sutured to the remaining PGM

Three stab incisions are made in the palate. Two at thpterygoid hamulae and one just before the posterior nasal spine. Using a 2-0 non-resorbable polyester thread mounted on a cutting needle, the periosteum and fibromuscular layer of the posterior nasal spine is entered sideways. The thread is then guided downwards to the free edge of the soft palate using multiple in and out sutures, each through the same hole. The needle emerges on one side of the uvular base and then passed sideways through the uvular base to emerge on the contralateral side. The thread is then passed upwards towards the posterior nasal spine in the same manner as before. At the posterior nasal spine, the thread is tightly knotted and buried in the stab incision which is subsequently close using resorbable thread. The same steps are repeated twice more on either side of the palate at the Pterygoid hamulae