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Uvulopalatopharyngoplasty (UPPP) & Coblation Tongue Channelling

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Uvulopalatopharyngoplasty (UPPP) & Coblation Tongue Channelling Introduction

Uvulopalatopharyngoplasty (UPPP) and coblation tongue channelling are surgical procedures performed to treat snoring and obstructive sleep apnoea (OSA). These conditions are caused by airway obstruction during sleep, leading to poor oxygenation, fragmented sleep, and excessive daytime sleepiness.

UPPP involves removing the tonsils, repositioning the soft palate to widen and stabilise the airway at the level of the soft palate and trimming the uvula. Coblation tongue channelling is a minimally invasive procedure that uses radiofrequency energy to stiffen and slightly reduce the bulk of the tongue base, helping to open the airway during sleep and prevent collapse.

These procedures are often performed together as part of multilevel surgery to address multiple sites of airway narrowing and collapse.

Reasons for surgery

UPPP and coblation tongue channelling may be recommended for patients with:

  • Obstructive Sleep Apnoea (OSA) that is moderate to severe
  • Snoring that disrupts bed partners or household members
  • Failure to tolerate CPAP therapy, the standard non-surgical treatment
  • Anatomical narrowing at the soft palate and tongue base on sleep endoscopy
  • Upper airway resistance syndrome – narrowing of the airway causing sleep disturbance and fatigue.

These procedures are typically considered when conservative measures (weight loss, CPAP, or oral appliances) are ineffective, poorly tolerated, or declined.

Benefits of the procedure

  • Reduced or eliminated snoring & reduced partner complaints/distress
  • Improved breathing during sleep
  • Better sleep quality and reduced daytime sleepiness
  • Improved oxygen levels during the night
  • Reduced long-term health risks related to untreated OSA (e.g. high blood pressure, heart disease, stroke)
  • Cure or significant reduction in OSA severity
  • Improved quality of life

Multilevel surgery, when appropriately selected, has been shown to offer durable improvements in sleep parameters and patient well-being.

Risks & complications

While generally safe, potential risks include:

  • Throat and tongue pain for 1-3 weeks
  • Bleeding, which may require intervention
  • Infection or delayed healing
  • Voice changes or nasal regurgitation (almost always temporary)
  • Swallowing difficulties (almost always temporary)
  • Airway swelling or scarring (rare)
  • Persistent or recurrent snoring/OSA, particularly if severe OSA or obesity present
  • Altered taste sensation in throat or tongue (almost always temporary)
  • Tongue weakness (very rare)

All potential risks will be discussed with you by Dr Phillips based on your personal medical history and airway anatomy.

Alternative treatments

Non-surgical options that may be considered include:

  • CPAP therapy – highly effective, but not tolerated by 40-50% of patients
  • Mandibular advancement splints (oral devices) – suitable for mild to moderate OSA or those with jaw-related obstruction
  • Lifestyle changes such as weight reduction, alcohol moderation, and sleep posture adjustment
  • Nasal surgery if significant nasal obstruction is contributing or to facilitate CPAP or MAS therapy

These treatments may be offered in combination with or prior to considering surgery.

Pre-operative instructions

Fasting

No solid food for 6 hours before surgery and clear fluids only (water, black tea) up to 2 hours before.

Medications

Inform Dr Phillips of any medications, especially blood thinners, which may need to be temporarily stopped.

Illness

Notify our clinic if you are unwell prior to surgery, as rescheduling may be necessary for safety.

Procedure details

  • Performed under general anaesthetic
  • Takes approximately 90 minutes
  • All surgery is done through the mouth, with no external incisions
  • UPPP removes or reshapes soft tissue at the back of the throat
  • Coblation tongue channelling reduces the tongue base volume using a plasma field generated by radiofrequency energy
  • Most patients stay overnight

Uvulopalatopharyngoplasty (UPPP)

  • Tonsils are removed if still present.
  • Excess tissue from the soft palate and uvula is trimmed, tightened and repositioned to widen the airway
  • Bleeding is addressed with electrocautery
  • The surgery is performed through the mouth under general anaesthetic.

Coblation Tongue Channelling

  • Uses controlled radiofrequency energy to create small internal channels in the tongue base.
  • These channels gradually scar and shrink, reducing the bulk of the tongue.
  • This helps open the airway behind the tongue.
  • Unlike traditional tongue surgery, coblation does not involve cutting or removing tissue from the tongue surface.
  • This technique reduces the risk of bleeding and postoperative complications and preserves normal tongue movement and sensation.
  • This procedure is often performed alongside UPPP for multilevel airway improvement.

Post-operative care & recovery

Pain

  • Pain is expected for 2-3 weeks, especially in the throat and tongue.
  • Take regular pain medication as advised (e.g., paracetamol and ibuprofen).
  • You will be prescribed stronger pain relief (such as tapentadol or oxycodone) for short-term use.

Diet

  • Start with soft foods like soups, yoghurt, scrambled eggs, smoothies.
  • Avoid spicy, acidic, or rough foods that may irritate healing tissue.
  • Drink plenty of fluids to stay hydrated.

Activity

  • Rest at home for 2 weeks depending on your recovery.
  • Avoid strenuous activity, gym, and heavy lifting during this time.
  • You may return to work when comfortable, usually after 10–14 days.

Bleeding

  • Minor blood-stained saliva is common
  • Fresh red bleeding or clots require urgent medical attention

What to watch for

Seek urgent care if you experience:

  • Bright red bleeding
  • Difficulty breathing
  • Inability to swallow fluids
  • Fever above 38.5°C
  • Signs of dehydration

Follow-up instructions

You will be reviewed by Dr Phillips 1–2 weeks post-operatively. If further sleep testing is required, this will be arranged to assess the outcome of your surgery.

References

The reference is used in this (SAMS trial) Is MacKay S, Carney AS, Catcheside PG, Chai-Coetzer CL, Chia M, Cistulli PA, et al. Effect of multilevel upper airway surgery vs medical management on the apnea-hypopnea index and patient-reported daytime sleepiness among patients with moderate or severe obstructive sleep apnea: The SAMS randomized clinical trial. In: JAMA – Journal of the American Medical Association. American Medical Association; 2020. p. 1168–79.

Frequently asked questions (FAQ)

  • Will this cure my sleep apnoea or snoring?

    Surgery can significantly improve or even resolve symptoms in carefully selected patients. While it may not “cure” OSA in all cases, many experience a marked reduction in snoring, apnoea events, and sleep disturbance.

  • What evidence supports surgery for sleep apnoea?

    The Sleep Apnoea Multilevel Surgery (SAMS) trial, a high-quality randomised clinical study, showed that UPPP combined with tongue channelling significantly improved sleep outcomes compared to best medical management in patients unable to tolerate CPAP.

    • Apnoea-Hypopnoea Index (AHI) reduced by 27 events/hr in the surgical group (vs 10 in the medical group)
    • Daytime sleepiness (Epworth Sleepiness Scale) dropped from 12.4 to 5.3 post-surgery
    • Snoring severity, oxygenation, and sleep quality all significantly improved
    • These improvements were durable, with long-term follow-up (~3.5 years) showing ongoing benefit

  • Does weight loss explain the benefit of surgery?

    No. The SAMS trial showed that BMI remained stable in both the surgical and medical groups. Improvements in OSA were attributed to anatomical correction, not weight change.

  • What if I still need CPAP after surgery?

    Surgery may reduce the pressure required on CPAP or make it more tolerable. In some cases, patients may still need CPAP but find it significantly easier to use after their airway has been improved.

  • Is this painful?

    Yes, but it is manageable. Throat and tongue pain typically peaks around day 5–7 and improves steadily. Pain relief and hydration are key to recovery.

  • Are there long-term risks?

    Complications are rare. Most patients recover well. Dr Phillips takes care to preserve speech and swallowing function.

  • Will my voice or swallowing be affected?

    Temporary changes may occur. Permanent changes are rare, especially with modern surgical techniques like modified UPPP and coblation.

  • How successful is the surgery in the long term?

    The SAMS trial showed that surgical improvements in OSA metrics remained durable at 3.5 years post-op. AHI reductions of 24 events/hr and sustained quality-of-life improvements were observed.

  • What happens if I don’t get surgery?

    If untreated, moderate to severe OSA can lead to ongoing fatigue, poor quality of life, cardiovascular issues, and increased health risks. If CPAP is not an option, surgery offers a valid and evidence-based alternative.

  • What happens if I have already had my tonsils out (previous tonsillectomy)

    In cases of previous tonsillectomy Dr Phillips will perform a scarplasty with careful dissection and reposition of soft palate tissue and muscle to achieve a similar outcome.

Related conditions

Book a consultation

If you’d like to discuss this procedure or explore suitable treatment options, please get in touch with Dr Nicholas Phillips’ clinic.

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Australian and New Zealand Rhinologic Society
Australian Society of Otolaryngology and Head and Neck Surgery
Royal Australasian College of Surgeons
International Surgical Sleep Society & Australasian Sleep Society
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