Are you or someone you know having surgery on the uvula, or considering having surgery?

We understand that helpful information can be hard to find.

This post provides illustrations and information regarding indications for uvula surgery (uvula growth removal, uvulectomy, and uvuloplasty), how uvula surgery is performed step-by-step, side effects, complications, and outcomes in the short-term and in the long-term.

The post was written by an Ear, Nose, and Throat (ENT) surgeon and took over 30 hours to complete.

At the end of the post, there is a link to a post on uvula anatomy, physiology, and disorders.

Types of uvula surgery. A) Uvulopalatal flap, B) Tissue sparing uvulopalatopharyngoplasty, C) Modified uvulopalatopharyngoplasty with uvulopalatal flap, and D) Classic uvulopalatopharyngoplasty. CamachoMD.com
Types of uvula surgery. A) Uvulopalatal flap, B) Tissue sparing uvulopalatopharyngoplasty, C) Modified uvulopalatopharyngoplasty with uvulopalatal flap, and D) Classic uvulopalatopharyngoplasty.

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Summary for information about the uvula and uvula surgery

There are multiple reasons for performing surgery on the uvula, to include having growths on the uvula (such as warty growths (papillomas) or bumps on the surface of the uvula (cysts)) and having a long and/or large uvula that is worsening snoring or is causing throat discomfort. 

If the uvula is longer than 1.5 centimeters (slightly longer than half an inch), then a surgeon may offer a procedure to help reduce the size.

If the surgeon removes part of the uvula, then it is called a partial uvulectomy.

If the surgeon removes the entire uvula, it is a complete uvulectomy.

Cutting, folding and sewing the tissue (suturing) are known as  uvuloplasties.

Long uvula with blue arrow pointing to the uvula. The uvula is consistent with a grade 4 uvula. CamachoMD.com
Long uvula with blue arrow pointing to the uvula. The uvula is consistent with a grade 4 uvula.

Background information

When is uvula surgery (uvulectomy or uvuloplasty) recommended?

Uvula surgery could be recommended when the uvula is too long and the patient snores or is having symptoms caused by the uvula being too long.

Some patients may have growths on the uvula and removal may be recommended to help determine what the growth is.

Uvula surgery is generally elective unless the patient has cancer or a severe infection (an abscess). Luckily, both of these are quite rare.

Some patients with an infection of the uvula (uvulitis) could go on to develop a severe infection (abscess). Once an abscess has developed, surgery of the uvula may be recommended.

Uvula surgery planning showing the place that it will be cut (shown in black dashes). CamachoMD.com
Uvula surgery planning showing the place that it will be cut (shown in black dashes).

Will surgery to shrink the uvula get rid of snoring?

Snoring is often due to the soft palate. However, since the uvula hangs off of the soft palate, it also contributes to snoring.

Surgery for snoring typically involves both the soft palate and the uvula (if the uvula is long and/or large).

If the uvula is operated on, but the soft palate is not, then snoring could be decreased some. But, in order to treat the snoring more effectively, the soft palate may need to be addressed as well.

If a patient snores and does not have obstructive sleep apnea, then a partial uvulectomy combined with a palate procedure (such as radiofrequency ablation of the soft palate) is a common choice for reducing snoring.

If there is a growth and it is removed, can they tell us what it is?

Yes, after the removal of a growth from the uvula, the surgeon will send the growth to a pathologist.

The blue arrow is pointing to a papilloma (growth) on the uvula. CamachoMD.com
The blue arrow is pointing to a papilloma (growth) on the uvula.

The pathologist will evaluate the growth and can determine what the growth is. 

A benign mass is when the growth is not cancer. A malignant mass is when the growth is found to be cancer (rare, but possible).

Where are uvula surgeries performed?

Uvula surgeries can often be performed in the clinic by using topical and injectable medications (anesthetics).

However, if there are additional surgeries or if the patient may not tolerate the procedure, then it could be done either in a surgical center or in a hospital operating room.

When should someone avoid surgery on their uvula for snoring?

In general, if the uvula is 1 cm in size or less, then it might be better to just leave it alone.

A study reviewing the international literature (Dr. Chang and colleagues) found that when a uvula is longer than 1.5 centimeters and is wider than 1 centimeter, then the uvula is too long or too wide, respectively.[1]

Many surgeons now advocate to leave a portion of the uvula and to not completely remove the uvula.[2]

The early days of uvula surgery (the 1950s to 1990s) were met with the complete removal of the uvula. [3, 4]

Uvulopalatopharyngoplasty. This is the classic type performed in the 1950s to 1980s. CamachoMD.com
Uvulopalatopharyngoplasty. This is the classic type performed in the 1950s to 1980s.

The movement to preserve the uvula started in the 1990s.[2]

Dr. Powell and colleagues published a study in which they folded the uvula and then sutured it to the soft palate.[2]  This preservation technique involved folding the uvula in a technique called “a reversible uvulopalatal flap”. [2, 5]

Over the last few years, some have advocated for the uvula to be trimmed to about 1 cm in length.[5]

Throat appearance after tonsillectomy with pharyngoplasty. The uvula was trimmed, but is now a normal length. CamachoMD.com
Throat appearance after tonsillectomy with pharyngoplasty. The uvula was trimmed, but is now a normal length.

How are uvula surgeries performed step by step?

Uvulas can be partially or completely removed.

If the surgery is minimal, then it could be done in the clinic. If the surgery is more involved, then patients usually go to the operating room.

If the uvula is partially removed, it is a partial uvulectomy.

If the patient is operated on in the clinic, then topical medicine (anesthetic) is given first on the surface of the soft palate and the uvula itself.

Uvula surgery with spraying of medicine (topical anesthetic) on the surface of the throat and uvula. CamachoMD.com
Uvula surgery with spraying of medicine (topical anesthetic) on the surface of the throat and uvula.

The procedure can be performed in the clinic or in the operating room depending on the patient.

If the uvula is completely removed, it is a complete uvulectomy.

The remainder of the procedures are the same whether performed in the clinic or in the operating room:

  • Injectable medication (local anesthetic) is injected into the uvula and/or soft palate,
  • The uvula is grasped with an instrument and is then cut with a second instrument (either metallic cutting instruments or instruments that cauterize as they cut).
  • In a uvuloplasty (uvulopalatal flap), the skin-like tissue (mucosa) on the surface of the uvula and soft palate are removed and the uvula is folded up and is sutured to the soft palate.[5]
Uvula surgery planning showing the place that it will be cut (shown in black dashes) between the two black arrows. CamachoMD.com
Uvula surgery planning showing the place that it will be cut (shown in black dashes) between the two black arrows.
Large uvula being trimmed to a more normal length. Given that the uvula is about 2 centimeters, in this illustration it is being trimmed to about 1 centimeter. CamachoMD.com
Large uvula being trimmed to a more normal length. Given that the uvula is about 2 centimeters, in this illustration it is being trimmed to about 1 centimeter.
Uvula surgery, showing the uvula after the tip has been cut. CamachoMD.com
Uvula surgery, showing the uvula after the tip has been cut.
Uvula after cutting off the tip. Note that it is now about half the length. CamachoMD.com
Uvula after cutting off the tip. Note that it is now about half the length.
Shortened uvula after cutting it and it has healed. CamachoMD.com
Shortened uvula after cutting it and it has healed.

What are the short-term side effects and complications from a uvulectomy or uvuloplasty?

Short-term side effects from uvula surgery include:

  • Mild throat pain,
  • Low-grade fever,
  • Mild difficulty with swallowing, and
  • Mild swelling.

Short-term complications from uvula surgery include:

  • Significant pain,
  • Significant swelling (edema),
  • Infection with a fever (above 101.5 Fahrenheit),
  • Bleeding from the uvula,
  • Hematoma (collection of blood under the mucosa of the remaining uvula), and/or
  • Uvula necrosis (tissue damage that can lead to the significantly damaged (necrotic) portion of the uvula falling off).
Uvula hematoma. There is a collection of blood under the skin-like surface (mucosa). The hematoma is outlined with dashes. CamachoMD.com
Uvula hematoma. There is a collection of blood under the skin-like surface (mucosa). The hematoma is outlined with dashes.

What is seen in patients who have uvular necrosis?

Patients can develop a uvula that then becomes light-colored or white in some cases. That portion of the uvula that is discolored might eventually fall off (could take a few to several days).

A review article found that in patients who had uvular necrosis (for non-uvula surgery cases), that impingement with devices and suctioning on the uvula were major risk factors for the necrosis. [6]

What are the long-term side effects and complications from a uvulectomy or uvuloplasty?

Two long-term side effects from uvula surgery include:

  • Globus sensation (feeling like something is stuck in the back of the throat), and
  • Persistent mild discomfort in the back of the throat.

Three rare, long-term complications from uvula surgery include:

  • Velopharyngeal insufficiency (the back part of the throat doesn’t close off all the way and patients can have air and liquids go into the back part of the nose),
  • When combined with uvulopalatopharyngoplasty (UPPP), two very rare complications include nasopharyngeal and oropharyneal stenosis, and
  • Persistent pain.

How long is the recovery after uvula surgery?

Typically 1-2 weeks.

After cutting or repositioning the uvula, the throat has to heal. It can take 1-2 weeks for the throat to form new mucosa (similar to skin, but in the throat).

Is it painful to have surgery on the uvula?

Yes, it is painful. But, surgeons prescribe medications that help to control the pain.

The medications prescribed can vary, but could include topical medications as well as oral medications.

Topical medications include viscous lidocaine that patients swish, gargle and spit out.

Oral medications that are prescribed may include acetaminophen and in some cases a narcotic medication (such as oxycodone) for the moments in which there is more significant pain.  

Does the throat feel different after uvula surgery?

Patients will likely feel different for some time after the surgery.

Initially, there is a pain.

Then, the mucosa (skin-like tissue) has to regrow to cover the exposed muscle (unless the surgeon closed the mucosa with sutures).

Scar tissue has to form which can take several weeks.

The nerves at the site of the removal of the uvula send signals to the brain that the throat and uvula are different.

It may take patients months to get accustomed to the new sensation(s).

Do patients feel like there is something stuck in the throat (globus sensation) after surgery on the uvula?

It is known that when the uvula is completely cut off, then patients can feel like something is stuck in the back of the throat.

This sensation is called a “globus sensation”. 

Globus sensation has been observed in patients who had a uvulopalatopharyngoplasty (tonsillectomy with suturing of the back of the throat, plus surgery on the uvula) or uvulopalatoplasty (surgery of the back of the throat and uvula, without a tonsillectomy).[7]

Is it possible to reverse a uvulectomy or a uvuloplasty?

Once the uvula is cut off (completely or partly), it cannot be put back.

The musculus uvulae is a muscle, so once it is cut away, it is gone.

On the other hand, a uvuloplasty can sometimes be reversed. If the uvuloplasty is performed with folding of the uvula and suturing of the uvula, then it is possible that the uvula could later be unfolded and separated from the soft palate muscle.

Throat appearance after modified uvulopalatopharyngoplasty with uvulopalatal flap. The skin-like surface (mucosa) of the uvula and soft palate was removed and the uvula was folded up and was sutured to the soft palate. CamachoMD.com
Throat appearance after modified uvulopalatopharyngoplasty with uvulopalatal flap. The skin-like surface (mucosa) of the uvula and soft palate was removed and the uvula was folded up and was sutured to the soft palate.

Although a reversal is potentially possible in the case of a uvuloplasty, it would likely require a surgery in the operating room with general anesthesia.

The challenge with reversing a uvuloplasty that has been folded is that there is scar tissue that makes it difficult, if not impossible (if significantly scarred down) to separate the uvula from the soft palate.

How long does it take to get the tissue exam results back from the pathologist?

The length of time from when a growth is removed from the uvula and the final results of the pathology report can vary from institution to institution, but generally, it can take about 1 week.

Can a uvula grow back?

Because uvulas are composed of muscle, it does not grow back.

However, if a patient has their uvula trimmed, then it could still vibrate and over time get longer and wider due to vibratory trauma.

A link to a post on this website to learn about the anatomy, physiology, and disorders of the uvula can be found here:

What is the CPT code for uvula surgery?

The CPT code is 42140, which is excision and destruction procedures of the palate and uvula.

Government Disclaimer: The views expressed in this website are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

References:

1.            Chang, E.T., et al., The relationship of the uvula with snoring and obstructive sleep apnea: a systematic review. Sleep Breath, 2018. 22(4): p. 955-961.

2.            Camacho, M., et al., Tissue-Sparing Uvulopalatopharyngoplasty for OSA: Conservative, Compassionate and Possibly just as Effective. Indian J Otolaryngol Head Neck Surg, 2015.

3.            Ikematsu, T., Study of snoring. 4th report. J Jpn Otol Rhinol Laryngol Soc, 1964. 64: p. 434-5.

4.            Yaremchuk, K. and L. Garcia-Rodriguez, The History of Sleep Surgery. Adv Otorhinolaryngol, 2017. 80: p. 17-21.

5.            Powell, N., et al., A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep, 1996. 19(7): p. 593-9.

6.            Reid, J.W., et al., Postoperative uvular necrosis: A case series and literature review. Laryngoscope, 2019.

7.            Franklin, K.A., et al., Effects and side-effects of surgery for snoring and obstructive sleep apnea–a systematic review. Sleep, 2009. 32(1): p. 27-36.