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Radiofrequency Palatal Myoplasty (RPM), Also known as somnoplasty
Radiofrequency Palatal Myoplasty (RPM), Also known as somnoplasty,
and submucosal radiofrequency uvulopalatoplasty (SRUP), it has been
used in urology, cardiology, and neurology as well as for liver
tumor ablation. It provides tissue ablation in a very precise and
controlled manner. In RPM it is applied submucosally to partially
ablate the muscle of the soft palate in a series of treatments,
with resultant thinning (volumetric reduction) and stiffening (fibrosis
with contraction) of the muscle layer (10).
It was first described by N.B. Powell from Stanford University,
California (6). It has been effective
in controlling snoring and reducing daytime somnolence in mild sleep
disordered breathing. Powell documented palatal shrinkage following
the procedure.
Coleman 7 showed a reduction of snoring to a level which was no
longer disturbing to the bed partner in 75% of treatment recipients.
The Epworth sleepiness scale 26,27 measurement of subjective daytime
somnnolence also improved. All studies have shown minimal post-operative
symptoms relating to inflammation, and minimal complications. Significant
improvement in obstructive airway parameters has not been consistently
demonstrated (10,15) with palatal RPM
alone. However the tongue base radiofrequency myoplasty has shown
improvement in respiratory distress index (RDI) and is under investigation
(16). More recent RPM studies have
shown bed partner satisfaction rates of 77 - 96 % (17,19,25),
with minimal pain compared to UPPP and LAUP (21).
Follow up studies are few as yet but some relapse as in UPPP and
LAUP is likely: further RPM treatment however can be expected to
be both acceptable to the patient and successful in correcting any
relapses (22). Instruments used to
generate and transfer radiocautery do not need to be highly sophisticated
and expensive (25).
References List
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