Guizhou Provincial People’s Hospital Surgical Record Outpatient Number: Peng Yikun, Department of Otolaryngology, Guizhou Provincial People’s Hospital Hospital Hospital Resident Number: 223343 Patient Name: Mao Changlin Age: 55 Gender: Male Diagnosis before surgery: Obstructive sleep apnea hypoventilation syndrome (severe) Diagnosis after surgery: Obstructive sleep apnea hypoventilation syndrome (severe) Name of surgery: Combined hard palate amputation soft palate advancement + H-UPPP Surgery Surgeon: Peng Yi-kun Assistant: Huang Xing-yu Type of anesthesia: general anesthesia Anesthesiologist: Date of surgery: April 10, 2009 2:00PM Start 7:10PM Stop Surgical procedure: The patient is supine, after successful general anesthesia via nasal cannula, routine disinfection, head wrapping and towel laying. (1) An opener was placed to expose the pharyngeal cavity and the tonsils were seen to be large bilaterally. The soft palate was loosely collapsed, the hard palate was high arched, the soft palate was too long, the oropharyngeal cavity was narrow, and the posterior lingual space was narrow. (2) Along the edge of the junction of the right tonsil and palatoglossal arch, the mucosa was incised with a sickle-shaped knife in an arc from above downward, and the mucosa at the junction of the tonsil and palatoglossal arch was incised downward along the semilunar fold of the palatoglossal arch. The peeler was used to separate the palatoglossal arch and tonsil downward, exposing the upper pole of the tonsil, peeling downward along the perineum to the lower pole of the tonsil, leaving only a thin tip, removing the tonsil completely with a trap, and compressing to stop bleeding; check for residual tonsils and active bleeding. Part of the hypertrophic mucosa of the palatopharyngeal arch was removed, and the palatopharyngeal arch and palatolingual arch were closed with 7 sutures. In the same way, the left tonsil and part of the hypertrophied mucosa of the palatopharyngeal arch were removed and the palatopharyngeal arch and palatolingual arch were sutured. (3) An inverted U-shaped incision was made on both sides of the midline of the soft palate with a small ball cutter in the mucosal layer, with the highest point about 2.0 cm from the edge of the soft palate. Excess adipose tissue was removed, muscle tissue (palatal sail tensor, palatal sail levator) and palatine healthy membrane were preserved, excess soft palate oropharyngeal side mucosa was cut away, and more soft palate nasopharyngeal side mucosa was preserved. The mucosa on both sides of the uvula was cut with the middle nail and the excess fatty tissue was removed with a hemostat. The mucosa must be aligned at the junction of the soft palate and the uvula. When suturing the mucosa of the uvula, it should be sutured from the root of the uvula, and both sides should be sutured symmetrically to prevent the mucosa from shifting to one side and causing too little mucosa on the other side. (4) Disinfect the oral cavity with iodine, and make a U-shaped incision with a circular knife 1.0 cm from the gingival margin of the second molar. The mucoperiosteal flap was bluntly separated from the mucosa at the incisors to expose the horizontal plate of palatal bone and to stop bleeding by electrocoagulation if necessary. At the junction of the hard and soft palate, the palatal key membrane was cut with a sharp knife, and the hard palate bone was removed with a lance-like biting forceps about 01.0 cm, with strict hemostasis. A circular needle with 7 threads was passed through the small hole of the hard palate from the bottom to the top, then between the mucoperiosteal flaps of the hard palate, and then through the small hole of the hard palate from the top to the bottom. The soft palate was lifted upward by about 1.0 cm. The cavity was flushed with Qingda saline and examined for a small amount of active exudate. Intraoperatively, the oral cavity and hypopharynx were filled with Vaseline gauze, and the patient returned to the ICU with a tube.(5) After the operation, the procedure went smoothly; intraoperative bleeding was about 800 ml, and the specimen was sent for examination.