Elevoplasty

by Dr. Christopher Chang, last modified on 4/13/21.

Elevoplasty will be available in our practice in the first quarter of 2021.

Elevoplasty is a procedure that is performed in a doctor’s office to treat primary snoring. The procedure lifts and stiffens the soft palate tissue at the top and back of the mouth to help reduce snoring. It provides a therapeutic option for patients experiencing snoring, but is not intended to treat patients with obstructive sleep apnea. It is an alternative for those patients seeking relief from snoring who are not interested in wearing an oral appliance at night and who are not willing to undergo more invasive surgery. There is also a less aggressive type of procedure called injection snoreplasty which does stiffen, but does not provide any lift.

For a complete list of procedures to treat snoring, click here.

The key differentiating factors that distinguish elevoplasty from other similar procedures including pillar and snoreplasty are:

• The three implants placed in the soft palate are absorbed by the body over 6 months.
• The implants both stiffen AND lift the soft palate. The stiffness occurs from the implant itself as well as the scar tissue that develops as the implant is absorbed by the body. The lift occurs due to small barbs on the implant itself that acts like a fish hook at time of implant placement. The amount of lift obtained is typically about 1-4mm which does not sound like much, but is adequate for snoring improvement. Furthermore, this amount of life minimizes any risk of velopharyngeal insufficiency.

The implant itself looks like the image below. It is about 2cm long. It is made of a suture material called polydioxanone which has been found to be nonantigenic and degrades into two substances that are both already present in the body: lactic acid and water. Complete resorption typically takes about 6 months.

The Perfect Patient

The perfect patient who would most benefit from this procedure is someone who snores due mainly to palatal vibration and does not have a bad gag reflex. The best way to determine whether the palate is the main culprit in a patient's snore is by having him/her imitate the snore while the palate is being examined. How is this accomplished? The patient should bring his/her partner and reproduce the snore with his/her partner's confirmation. While the snore is reproduced, fiberoptic nasopharyngoscopy is performed and if the soft palate is shown to be vibrating, elevoplasty may be of benefit. An even better way to confirm a palatal snore is to undergo a sedated endoscopic exam.

For most people, a "palatal" snore that is amenable to this treatment sounds like this:

Sample Uvula/Palate Snore #1
Sample Uvula/Palate Snore #2

A tongue base snore that sounds like this does not respond well to this type of treatment:

Sample Tongue Base Snore

If you are able to imitate the snore while sticking out the tongue, the snore is most likely from the uvula/palate.

The Procedure

The procedure is performed in the following manner:

Watch a video of how the procedure is performed below or click here.

What to Expect After the Procedure

You can expect a sore throat for two to three days after the procedure. Most individuals can return to work and normal activities the next day. Pain control with tylenol and/or motrin should be sufficient. You should avoid spicy foods, acidic foods, and alcohol for a few days after the procedure as it may cause some stinging. Other side effects may include minor bleeding, mild pain or discomfort, temporary swelling of the soft palate, trouble swallowing, and bruising.

In a clinical trial, three out of four patients saw a reduction in snoring 30 days after having the procedure. On average, patients also saw a reduction in daytime sleepiness and an improvement in sleep quality. No long term data currenlty exists to say whether this improvement will last for years given this product has only been available since 2019.

Keep in mind that even with elevoplasty (or any other snoring treatment), snoring may persist due to the sound coming from many other different levels of the airway (ie, tongue vibration, nose vibration, cheek vibration, throat vibration, etc). Click here for more info.

Another issue to keep in mind is that snoring is considered a COSMETIC problem and as such, any procedures used to treat snoring surgically will be an out-of-pocket expense for patients.

However, snoring may be indicative of an underlying medical condition like obstructive sleep apnea (OSA) for which treatment IS covered by insurance, though elevoplasty would be excluded. Treatment for OSA often helps snoring as a bonus side effect. In order to determine if a person's snore is due to OSA, a sleep study needs to be performed which can only be prescribed by a physician.

References

A new office-based procedure for treatment of snoring: The S.I.Le.N.C.E. study. Laryngoscope Investig Otolaryngol. 2020 Jan 22;5(1):24-30. doi: 10.1002/lio2.348. eCollection 2020 Feb.

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Elevoplasty

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