Do you know the identity of the most famous patient to ever have a uvulectomy?
The answer is ‘Dr Livingstone I presume’- David Livingstone had a uvulectomy in Cape Town South Africa in 1852 which was before he set off on his famous adventures in Africa. Interestingly Dr Livingstone may have a world record for many things but he certainly was not the first person to ever have a uvulectomy. Uvulectomy was described as far back as the time of Hippocrates and Galen.
What is a uvulectomy?
A uvulectomy is the removal of the uvula which is the bell shaped structure at the back of the throat. The uvula is the often depicted in cartoon scenes when the character screams and the audience sees the uvula quivering at the back of the throat.
Why have a uvulectomy?
Uvulectomies are done for a variety of reasons including: relief of snoring, management of sleep apnoea, reduction of the risks of death from asphyxiation associated with angioneurotic oedema. However uvulectomy is a relatively infrequent surgical procedure as compared to other ear, nose and throat surgeries.
Interestingly the connection between uvulectomy and Africa continues as uvulectomies are preformed in up to 20% of children at the naming ceremony within a week of birth in some African countries. Studies suggest that the reasons for uvulectomies at this young age include cultural rituals in addition to attempts to prevent growth retardation and fever. Sadly the very act of uvulectomy in these uncontrolled settings has resulted in neonatal deaths due to tetanus, bleeding and unintentional aspiration of the amputated uvula.
How is the uvulectomy carried out?
Usually a uvulectomy can be carried out under local anaesthesia as a day case. The surgeon uses cautery or laser therapy to remove the uvula.
What are the risks of the surgery?
In expert hands, the procedure is well tolerated. The main procedure related risks include bleeding and postoperative infection. However it is worth mentioning that the type of patient who requires a uvulectomy for sleep apnoea tends to have a high body mass index and generally is at a higher risk of peri operative events.
Patients usually report some post operative pain which can be controlled by simple analgesia and avoidance of solids until healing has taken place.
Long term the main risks include impaired gag reflex with attendant risk of aspiration in addition to nasal regurgitation of food. Patients who speak languages with guttural phonetics (sometimes called uvularly speech) such as Xhosa and Turkish may notice some speech impairment.
How much does a uvulectomy cost?
The costs of a uvulectomy varies depending on the location. There are insufficient data for policy makers to determine if uvulectomy is a cost-effective intervention.
What are the disadvantages of losing a uvula?
Interestingly the exact function of the uvula remains unclear. It is widely thought to have a role in speech and possibly in protection against infections. It had been suggested that the uvula helped animals to drink while bending down and that we humans had evolutionary remnants of this organ. However a fascinating study in Israel refuted this theory and concluded that it is indeed an accessory speech organ. Hence George Bernard Shaw was technically quite correct in 1911 when he cynically suggested that mercenary doctors could remove the uvula and leave the patient no worse off.