A case with palatal presentation of scleroma is presented due to its rarity and unusual manifestations. The patient presented with only palatal symptoms. Nasal endoscopy revealed signs of all three stages of scleroma: catarrhal, granulomatous and sclerotic stages. Histopathology was vital in the diagnosis. The patient was treated by medical therapy, and palatal symptoms were relieved by uvulopalatopharyngoplasty.

The aim of this study was to retrospectively survey patients who had undergone the uvulopalatopharyngoplasty (UPPP) operation over a two-year period, assessing loudness of snoring, sleep quality and patient satisfaction. A total of 271 patients were sent questionnaires to assess snoring and sleeping habits, with additional questions about pain and satisfaction with surgery. Those who did not reply were contacted by telephone. Seventy-four per cent of the target population were surveyed. Taking an improvement in snoring level of 50 per cent or greater, immediately post-operatively the overall success rate was 76 per cent; however, after two years the success rate fell to 45 per cent. Variables such as alcohol consumption and smoking were not found to influence results. On a post-operative pain scale of 1–10 the average was 7.5 and on a satisfaction scale of 1–10 the average satisfaction with surgery was five, 61 per cent of patients stating that they would not have this operation again. This study shows that the UPPP operation is successful in only 45 per cent of patients after long-term follow-up, that the majority of patients experience severe pain and that the overall satisfaction with surgery is low.

A questionnaire was sent to consultant Otolaryngologists (483) throughout the UK to identify any mortality associated with uvulopalatoplasty and other forms of palatoplasties for snoring and/or obstructive sleep apnoea. The response rate was 76.8 per cent (371). Six intra- and post-operative deaths were reported and four were known to have obstructive sleep apnoea. Life-threatening morbidity occurred in at least seven patients (three known apnoeic), two required immediate tracheostomy and two were managed in the intensive care unit. This suggests that the apnoeic patients undergoing palatoplasties experienced significant mortality and morbidity. Pre-operative sleep study should be performed in all snoring patients to identify the apnoeic subgroup. Continuous positive airway pressure, management of excessive obesity, elective tracheostomy and other strategies should be first considered before palatoplasties in these patients.

The Kamami technique of laser-assisted uvulopalatoplasty has recently been introduced into British practice as an office-based multistage procedure for the treatment of snoring and, in certain cases, for obstructive sleep apnoea. We have treated 50 patients with simple snoring, with a minimum follow-up of six months. Six-month telephone interview follow-up has assessed partner and patient satisfaction, as well as willingness to undergo the procedure again. We have found the procedure easy to perform with no serious intra-operative complications. Thirty-four (68 per cent) of patients' partners have been definitely satisfied with the results of treatment, with 11 (22 per cent) definitely unsatisfied. However, only 25 of these 34 satisfied patients (76 per cent) would be prepared to undergo the treatment again with postoperative pain and discomfort cited as the reason in those who would not. The failure rate doubled between one and six months post-operatively. There have been no serious complications but a 40 per cent minor side-effect rate is noted. These results are discussed in the context of previously reported results, with consideration of future strategies to improve outcome.

Ingestion of small bones often causes oropharyngeal trauma. I present an unusual case of a potentially lifethreatening haematoma of the soft palate caused by a chicken bone. To my knowledge, this is the only case reported in the English literature.