Harmonic Scalpel\uae in the treatment of snoring

Primary snoring is usually considered to be a consequence of soft palate vibration caused by a partial upper airway collapse during sleep. Uvulopalatopharyngoplasty (UPPP) is a surgical treatment used to remove tissue in the throat for snoring and/or sleep apnea syndrome. UPPP is still the most frequently used surgical treatment for snoring and/or sleep apnea syndrome. Innovative advances have recently introduced regarding instrumentation, energy sources, and devices aimed at facilitating surgical procedures in terms of efficient hemostasis, tissue legation and dissection, as well as reduction in surgical time: although curative for many patients, these procedures present side effects. The Ultracision Harmonic Scalpel\uae is an ultrasonic cutting and coagulating surgical device. The equipment consists of a generator, an hand-piece, and specific inserts. The mechanism of the Harmonic Scalpel\uae (HS) is based on transforming electrical energy into mechanical movement of 55.5 kHz frequency. The high-frequency ultrasonic vibrations produced by the HS cause an effect referred to as cavitation whereby the collagen and proteoglycans in the tissue become denatured and then combine with the tissue fluids to form a coagulum. The pressure exerted on the tissue by the blade surface collapses blood vessels and allows the coagulum to form a hemostatic seal. The HS controls bleeding by coaptive coagulation at low temperatures, ranging from 50\ub0C to 100\ub0C. By contrast, electrosurgery and laser coagulate by burning (obliterative coagulation) at higher temperatures (150-400\ub0C). The vibration frequency of HS is optimal for soft tissue and does not cut mineralized tissue (lower frequency waves need to be utilized) In UPPP, among the available hand-pieces and inserts, a specific hand-piece and insert was preferred: the insert, shaped like scissor, had a sharp inner beveled radius forcutting under tension, a blunt outer radius for coaptive coagulation, and a flat side for surface coagulation. In all the patients treated, the HS allowed rapid and easy intraoperative management and a precise and safe cut, especially in difficult anatomic sites. The operating fields were blood free with perfect intraoperative visibility. These features facilitate the use of the HS in tight spaces, where precision is essential. Postoperatively, all patients had a recovery of snoring (no complications with regard to haemostasis or other major complication, were noted in our study group), with an acceptable level of pain. \ua9 2010 Nova Science Publishers, Inc. All rights reserved