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Habitual snoring, a problem which is estimated to affect 40 million Americans, occurs when there is obstruction of the free flow of air through the passages of the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and the uvula. When these structures strike each other and vibrate during breathing, snoring results.
The problem is becoming increasingly prevalent as the population ages. Forty-five percent of normal adults snore, at least occasionally, and 25 percent are habitual snorers. Thirty percent of adults over the age of 30 are snorers. At middle age, the number reaches 40 percent. Snoring is a problem affecting spouses, family members and, occasionally, neighbors.
Snoring can be diagnosed as primary snoring (simple snoring) or obstructive sleep apnea (OSA). Primary snoring is characterized by loud upper airway breathing sounds during sleep without episodes of obstructive sleep apnea (cessation of breath).
OSA is a serious medical condition. Individuals with OSA experience frequent episodes of apnea during sleep contributing to an overall lack of restful sleep that can result in severe health risks, including heart attack and stroke. Often alertness and job performance suffer.
Snoring is caused by excessive tissue in the uvula and soft palate. Snoring can be a sign of Obstructive Sleep Apnea. OSA is caused by a combination of a floppy uvula and soft palate and the tongue falling back to shut off the postnasal space. Surgery to correct OSA involves the removal of the excess soft palate and uvula with uvulopalatopharyngoplasty, which is a hospital-performed operation requiring general anesthesia and an overnight hospital stay as well as a period of convalescence.
However, uvulopalatoplasty, the treatment for habitual snoring (as well as less severe cases of OSA) can be performed in doctors' offices or day surgery clinics. One method currently in use in some large metropolitan areas is laser-assisted uvulopalatoplasty. Laser equipment can be prohibitively expensive for some practitioners, with laser systems costing from $40,000 to $100,000 and special training for the practitioner and staff is required.. However, many doctors' offices are equipped with electrosurgical units or systems such as those sold by ValleyLab or Anthony Products costing $10,000 or less. The bipolar electrosurgical handpieces discussed herein are designed to be adapted to operate in conjunction with similar units that have a bipolar mode.
A study published in the July 1997 issue of Laryngoscope compared the results of performing uvulopalatopharyngoplasty (UPPP) and uvulopalatoplasty (UPP) utilizing electrosurgery with laser-assisted uvulopalatoplasty (LAUP). See, Gnuechtel et al. Electrocautery Versus Carbon Dioxide Laser for Uvulopalatoplasty in the Treatment for Snoring, Laryngoscope 107:848-854, July 1997.
The study concluded that the use of carbon dioxide laser offers no advantage over electrosurgery in performing UPP to treat snoring. The study compared postoperative pain, time off work, efficiency and the number of treatments required to achieve a satisfactory result.
The study states that LAUP has been criticized for its expense and the lack of controlled studies of this procedure. The specially designed lasers and oropharyngeal attachments are costly. Laser precautions must be enforced, specific rooms must be used and all surgical personnel require periodic laser safety training and medical supervision. Gnuechtel at 849.
Electrosurgery is now being used for outpatient cautery-assisted UPP in which selective tissue excision is the same as LAUP. This alternative is more economical in that standard equipment typically costs less and the procedure does not require special training of safety precautions. Gnuechtel at 849.
It should be noted that the electrosurgical procedures performed in the study utilized a Force 2 electrosurgical generator (Valleylab, Boulder, CO) in the pure cut power mode of 20. A hand-controlled monopolar electrosurgical pencil and needle electrode (#60-0182-001 Aspen Lab, Englewood, CO) was used to make the incisions. Gnuechtel at 850. The bipolar devices disclosed herein offer additional advantages over monopolar devices which will be discussed below.
Another study published in 2002 concluded that electrosurgically performed UPP is a good and cost effective alternative to other known treatments. See, Wedman and Miljeteig, Treatment of Simple Snoring Using Radio Waves for Ablation of Uvula and Sort Palate: A Day-Case Surgery Procedure, 112 Laryngoscope: 1256 - 1259, July 2002. Patients were found to be able to be discharged 1 hour postoperatively. It is noteworthy that the researchers used a snare-wire loop, originally designed for gynecological procedures, as a knife. This may be evidence that practitioners appear to be truly in need of specialized devices to perform UPP such as are being presented here.