For more information about the selection of palate procedures, including the Pillar Procedure, please see Dr. Kezirian’s blog entry about choosing the best palate surgery for snoring and sleep apnea.

One of the first surgeons to perform the Pillar Procedure

The Pillar Procedure is used to treat the palate in selected patients with snoring and mild or moderate obstructive sleep apnea. Although the Pillar Procedure has many attractive features, not every patient is an ideal candidate for the procedure. Dr. Kezirian was one of the first surgeons in the United States (and the first in California) to perform the Pillar Procedure. He delivers lectures around the world concerning the wide range of treatments available for patients with snoring and sleep apnea and can discuss whether the Pillar Procedure is right for you.

There are many surgeons who are new to the field of snoring and sleep apnea surgery but who are advertising themselves as experts and offering the Pillar Procedure to every patient they see. Dr. Kezirian takes a more careful approach, treating patients with this procedure based on a thorough understanding of his experience and that of others. The most important factor in obtaining good results is using the procedure only for patients who will obtain the greatest benefit. There are claims out there on other websites about the Pillar Procedure that are not true and are based on a misreading of the medical literature. Dr. Kezirian treats patients based not only on his extensive experience but also on the published research from other experts.

The Pillar Procedure can be performed in the office without requiring general anesthesia or sedation. Three to five woven implants are placed into the soft palate, and the procedure takes approximately 20 minutes. Their presence and the body’s normal response to them stiffen the soft palate over the course of 2-3 months. The implants are made of a material (trademarked as Dacron®) that has been used for decades in medical uses without any known adverse consequences.

Good results as a snoring surgery, especially in certain patients

There are a number of studies of the effectiveness of the Pillar Procedure in improving snoring. They have shown that there are certain types of patients that respond best. Of the family of palate stiffening procedures, the Pillar Procedure has shown the best long-term results. The Pillar Procedure has demonstrated only limited benefits for most patients with moderate to severe obstructive sleep apnea.

For additional information about the procedure, you can discuss the procedure with Dr. Kezirian, review information he has written about the Pillar Procedure for the About.com website.

Pillar Procedure image showing implants in place in the soft palate

Pillar implant used for treatment of snoring and sleep apnea

The following video presents a discussion of palate procedures, including the Pillar Procedure:

RISKS

Bleeding and infection

Bleeding and infection are rare after the Pillar Procedure. Patients will rinse their mouth with an antiseptic prior to the procedure to reduce the risk of infection. Patients should not use mouthwashes following surgery because many of these contain alcohol which can irritate the lining of the mouth and interfere with healing. A major factor in preventing serious bleeding is to avoid the use of aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks before and after surgery.

Displacement of the implants

The Pillar implants are designed to remain in the soft palate permanently. Rarely, the implants are displaced from their location and pushed out through the lining of your palate. This process occurs over the course of days to weeks, and usually the first sign is the appearance of the white tip of the implant on the surface of the soft palate. Patients will often feel this with their tongue. If this occurs, contact your doctor to have it removed with a brief, minor procedure. The implant can be replaced after the palate heals.

Difficulty swallowing or speaking

There will be some swelling after this procedure, but it should not interfere with swallowing or speech. Both of these are possible, however.

Throat dryness or feeling of something stuck in the throat

Any operation on the palate can affect the throat in unpredictable ways, and it is possible for some patients to dryness or a feeling that something is stuck in the throat. These are usually temporary, but they can be permanent.

Continued snoring

The goal of the Pillar Procedure is to reduce the loudness and frequency of disruptive snoring. However, many patients will continue to snore to some extent, even after successful surgery. Options for treatment, should snoring persist, include alternative treatments or placement of additional implants.

 

POSTOPERATIVE INSTRUCTIONS

NOTIFY DR. KEZIRIAN IMMEDIATELY IF YOU HAVE ANY TROUBLE BREATHING OR IF ANY BLEEDING DEVELOPS!

Pain control

Pain should be mild after this procedure for 1-3 days, and then it should improve dramatically. You may be prescribed some narcotic pain medication, but most patients obtain sufficient pain relief with acetaminophen (Tylenol®) alone, especially after the first day. You should take either medication as you need it for pain control, and try not to let the pain increase until it becomes intolerable before you take the medication. Avoid aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for one week because they can increase your risk of bleeding after surgery. Let your doctor know immediately if you are experiencing significant or prolonged pain.

Diet

Due to the pain and swelling that is to be expected, you may have some trouble eating and drinking for 1-2 days following the procedure. Most patients are able to continue with their normal diet, but it is helpful to avoid very hot (temperature) foods for several days because these can increase the amount of swelling and discomfort.

Ice in the mouth

Holding ice in the mouth while they melt and cool the surgical area can help with pain control.  Doing this for the first 2-3 days after surgery is somewhat similar to applying ice to a sprained ankle.  It is one of the safest ways to reduce pain and can make the healing process easier.

Minimize strenuous physical activity for 1 week

At a minimum, patients should walk at least three times a day starting the day after surgery. Walking and spending more time out of bed (walking or in a chair) rather than in bed are helpful because they reduce the risks of developing pneumonia or blood clots in the legs. However, patients should avoid strenuous activity for 1 week because that typically raises heart rate and blood pressure. For this reason, it can increase swelling or cause bleeding to start.

Do not use mouthwashes, lozenges, or throat sprays

Patients should not use mouthwashes, lozenges, or throat sprays following surgery because many of these contain alcohol that can irritate the lining of the mouth or numbing medication that can expose you to a serious complication when used for more than a couple of times.

Ear problems or jaw discomfort

The swelling in your throat that occurs after surgery can cause jaw pain or ear symptoms such as pain, pressure, or fullness. This is common and should improve within 1-2 weeks following surgery. It occurs because the soft palate and tonsils are next to the jaw and the small Eustachian tube that connects the space behind the eardrum to the top of the throat. Swelling in the throat can interfere with your ability to clear or pop your ears, and it can also be sensed by your body as pain coming from your ears even though the ears are not affected (a phenomenon called referred pain).

Additional questions

For any emergencies, please call 911.  For other questions, please contact Dr. Kezirian at eric.kezirian@med.usc.edu.  If you would like to speak with someone, please call the Nurse Line at 323-442-0190 during normal business hours. To speak with someone after hours or weekends, please call the Call Center at 323-442-5790 and ask to speak to Dr. Kezirian or whomever is answering calls for his patients.

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