Are you curious about the uvula? We understand that helpful information can be hard to find.

This blog post provides information and several simple illustrations to help teach you about uvula anatomy, physiology, and disorders. The post was written by an ear, nose and throat surgeon and over 30 hours were dedicated to the illustrations and writing.

At the end of this post, you will also find a link to a post about uvula surgery.

Uvula grades 1 to 4. A) grade 1: small sized, B) grade 2: medium sized, C) grade 3: large sized, and D) grade 4: very long (elongated). CamachoMD.com
Uvula grades 1 to 4. A) grade 1: small sized, B) grade 2: medium sized, C) grade 3: large sized, and D) grade 4: very long (elongated).

Disclaimer: This blog is meant for educational purposes only. The information is not meant to provide specific medical advice. You need to contact your own healthcare provider for health information specific to you. You may need to seek urgent or emergency care depending on your situation. We reserve the right to update, change, or delete any content at any point. Our cookie policy can be found in our Privacy Policy. Also, you must agree to the Terms & Conditions of the KingsMD.com website in order to continue.

Summary for information about the uvula:

The uvula is a muscular tissue that sits in the back of the throat that hangs down from the soft palate.

Is your uvula swollen?

Significantly swollen uvula. The black arrow is pointing to the uvula. CamachoMD.com
Significantly swollen uvula. The black arrow is pointing to the uvula.

Because the uvula is attached to the soft palate, when the palate vibrates during snoring, the uvula also vibrates during snoring.

A normal uvula is under 1.5 centimeters long and less than 1 centimeter wide.  

Despite its small size, the uvula functions to affect saliva production, speech, and breathing.

Disorders of the uvula are many and can include snoring, uvulitis (swelling) and abnormal uvula shape (bifid), and growths on the uvula.

Background information

What is the uvula?

The uvula is a muscular tissue that sits in the back of the throat that hangs down from the soft palate.

Healed uvula after cutting the tip of the uvula off. The black arrow points to the uvula. CamachoMD.com
Healed uvula after cutting the tip of the uvula off. The black arrow points to the uvula.

What does uvula mean?

Uvula comes from the Latin language and means “little grape.”

What does the uvula do?

The uvula has the following functions:

  • It produces thin saliva that helps to moisten the mouth (oral cavity) and throat (oropharynx).
  • The uvula also helps to move food down the throat when you swallow.  The uvula does this by helping to close off the back of the nose (nasopharynx), so that food can start to travel down the throat (pharynx).
  • It can affect speech (specifically consonants such as the ng sound)[1], and
  • It helps control the amount of air coming from the airway. The uvula helps to control the amount going out of the mouth and out the nose.[2]

What is the anatomy of the uvula?

The uvula is made up of many tissues to include skin-like tissue (mucosa) on the surface, fatty (adipose) tissue, tissue that helps hold things together (loose connective tissue), mucous (seromucous) glands, muscle, arteries, veins, lymphatics, and nerves.[2]

The uvula muscle is known as musculus uvulae.

The nerve that supplies the uvula is called the vagus nerve (the pharyngeal branch).

When the musculus uvulae is stimulated by the nerve, the uvula becomes wider and it becomes shorter (contracts).

By becoming wider and shorter (contracting), the uvula helps to guide the food (bolus) down the throat (pharynx).

What is the blood supply of the uvula?

The blood supply that goes away from the heart (arterial) is comprised of the ascending palatine artery (comes off the facial artery) and the greater palatine branch of the maxillary artery.[3]

The ascending palatine artery has branches that supply the soft palate coming from the anterior branch alone 25% of the time, posterior branch 35% of the time and 40% of the time both the anterior and posterior branches were present.[4]

What are the various abnormal shapes of the uvula?

The uvula can be too wide, too long and can be split in the middle (bifid uvula).

When the uvula is too wide and too long, it is known as uvular enlargement.

What causes a swollen uvula (uvulitis) in the short and long term?

Uvulitis is an enlargement or swelling of the uvula.

Uvulitis is typically an acute process that happens over a short period of time.

Uvular enlargement can happen over a much longer period of time (over months to years) and can cause a chronic problem in which the uvula is permanently elongated.

Swollen uvula. The uvula Is wide and swollen. CamachoMD.com
Swollen uvula. The uvula Is wide and swollen.

What causes swelling of the uvula (uvulitis) in the short term?

There are many possible causes for swelling, but some of the more common reasons include:

  • Allergic reactions,
  • Injury (such as from trauma, or hot temperature foods),
  • Surgery, and
  • Infections.

Allergic reactions can trigger swelling in the mouth and throat (including the uvula).

In patients with an allergic reaction, there is typically a rapid onset of swelling of the mouth and throat. Because the swelling can progress, these patients should see a healthcare provider.

A careful history and physical exam can help the healthcare provider determine what the next step should be.

Trauma can also cause uvulitis. Sometimes eating foods with a sharp edge or foods that are quite hot in temperature can cause the uvula to become swollen.

The blue arrow is pointing to a laceration (cut) on the uvula from eating food with a sharp edge. CamachoMD.com
The blue arrow is pointing to a laceration (cut) on the uvula from eating food with a sharp edge.

The surface of the uvula is made up of mucosa, which is thin and damage to the mucosa can cause swelling.

In many cases, uvula swelling due to trauma can be watched without having to do anything, if the swelling is not too significant.

Uvula turning white after burn, such as from eating hot food. CamachoMD.com
Uvula turning white after burn, such as from eating hot food.
Uvula during healing from burn. The tissue is growing over the muscle. With time, it should heal to be the same color as the surrounding tissue. CamachoMD.com
Uvula during healing from burn. The tissue is growing over the muscle. With time, it should heal to be the same color as the surrounding tissue.

Surgery is a potential cause of uvula swelling.

There are two main reasons that surgery causes swelling.

The first reason is that the endotracheal tube (breathing tube) that is placed into the airway can put pressure directly on the uvula. If the surgery is long, then the continuous pressure of the tube against the back of the throat can cause damage to the uvula.

Surgery of the throat can also cause uvula swelling. For example, in patients who undergo a tonsillectomy, the uvula is often moved to the side during the surgery by the placement of a catheter that moves the palate forward.

Sometimes the heat can be transferred to the uvula by the tools used to do the surgery, and the damage can cause swelling.  

Additionally, the lymphatics that drain the uvula can become impaired for several days after throat surgery (such as a tonsillectomy).

Typically, swelling due to surgery tends to resolve within a few to several days.

Infections, such as Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae are known to cause uvulitis.

In some cases, an infection that affects the uvula can also cause an infection of the epiglottis (a structure that is above the voice box (vocal cords)).

An infection of the epiglottis can be concerning for causing more airway obstruction (breathing difficulties).

Can uvulitis cause airway blockage?

In some cases, uvulitis can be a sign of epiglottitis (swelling of the epiglottis).[5-11]

Uvulitis and epiglottis can present with fever, sore throat and pain with swallowing (odynophagia).[9]

Depending on the patient’s history and physical exam, the healthcare provider may choose to do additional testing such as an x-ray or a scope in the nose that can be used to look at the airway (flexible airway endoscopy).

Sometimes the airway evaluation will need to be performed in the emergency room, intensive care unit or even in the operating room as intubation (placement of a breathing tube) may be needed.[9]

Although quite rare, an infection can become severe such as an abscess (collection of pus) and might need to be cut (incised) and drained.

What is a bifid uvula?

Bifid uvula. Note the tip of the uvula is split in the middle. Some people are born with a bifid uvula. The black arrow is pointing to the uvula. CamachoMD.com
Bifid uvula. Note the tip of the uvula is split in the middle. Some people are born with a bifid uvula. The black arrow is pointing to the uvula.

A bifid uvula is when the tip of the uvula is split in half.

The reason that it matters is that a bifid uvula can be predictive of a sub-mucous cleft palate, and that is a potential cause of speech problems.

In some patients, the soft palate does not close off completely and this can lead to air escaping through the nose during speech or liquids coming out of the nose during swallowing, and this is a problem known as velopharyngeal insufficiency.[12]

How common is a bifid uvula?

A large study evaluating about 24,000 school children found the prevalence of a bifid uvula to be 0.42%.[12]

How does a bifid uvula affect adenoid surgery?

Because a bifid uvula is a sign of a potential submucous cleft, surgeons may be conservative during adenoid surgery and may leave a small amount of adenoid tissue at the lower edge of the adenoids so that the palate can still close completely.

The concern with removing the adenoids completely is that the child could develop an incomplete closure of the back of the throat during swallowing and speaking (velopharyngeal insufficiency).

In severe cases of velopharyngeal insufficiency, the patient could have air escaping from the nose inappropriately during speech.

What is the normal length of the uvula? What is a long uvula?

Dr. Chang and colleagues reviewed the literature and found that a uvula that is greater than 15 mm in length was long, and a uvula that is wider than 10 mm is considered to be wide.[13]

Larger uvulas were associated with more severe snoring and obstructive sleep apnea.[13]

Small sized uvula consistent with grade 1 size. CamachoMD.com
Small sized uvula consistent with grade 1 uvula size.
Medium sized uvula consistent with grade 2 size. CamachoMD.com
Medium sized uvula consistent with grade 2 uvula size.
Long sized uvula consistent with grade 2 uvula size.
Very long uvula consistent with grade 4 uvula size. CamachoMD.com
Very long uvula consistent with grade 4 uvula size.

If a person has a long uvula and snores but does not want surgery, then what is the natural history of observation?

If a patient has a large or long uvula and does not want to have any procedures, then the uvula will likely remain about the same size or may get longer.

Given that uvula surgery is elective, the decision for surgery is usually going to be driven by the bedpartner complaining about the snoring.

Normally, people do not notice the uvula. However, if the uvula is quite large or quite long, then some patients may actually feel it in the back of the throat. 

So, the decision to observe or to have surgery is up to the patient.

How does the uvula cause or contribute to snoring?

When humans lie down on their back (supine position), the uvula moves back and in some people, the uvula can touch the back wall of the throat.

When the soft palate and uvula touch the back wall of the throat, the airflow becomes partly obstructed and the tissue starts to vibrate.

The vibrations can cause snoring.

Why does the uvula get longer and wider in patients who snore?

The back wall of the throat (pharynx) has the spine just deep to it; therefore, the uvula hits the front (anterior) part of the bony spine during snoring.

When people snore, the uvula hits the back wall of the pharynx (throat) repeatedly over the sleeping period.

The repetitive trauma can cause the uvula to swell and to become longer over time.

So, when the soft palate and uvula hit the hard bone, there is soft tissue swelling.  The swelling is due to fluid and cells coming into the area and the damaged tissue is repaired.

Over time, the swelling and damage can cause permanent changes with associated enlargement of the uvula in all directions so that it becomes thicker, wider and longer.

Are there any medical treatments that can help reduce the snoring caused by having a long uvula?

Some patients use an oral appliance or a tongue retaining device.

Both of these devices move the tongue forward, then the soft palate (along with the uvula) will also move forward.

Because the tongue is attached to the soft palate (by the muscle called the palatoglossus), by moving the tongue forward, the soft palate and the uvula should also move forward.

Another option is for the patient to use continuous positive airway pressure (CPAP) devices or auto-titrating positive airway pressure devices (APAP).

CPAP or APAP machines are the gold standard for eliminating sleep-disordered breathing such as obstructive sleep apnea.

However, in order for insurance to pay for CPAP or APAP, the patients will need to have a sleep study demonstrating at least 5 obstructions per hour, plus symptoms; or have at least 15 obstructions per hour, whether or not there are any other symptoms.

In patients who snore or have obstructive sleep apnea, the uvula could be operated on as a part of the surgical plan.

Because of the side effects and complications, surgery on the uvula needs to be carefully considered and the risks, benefits, and alternatives need to be thoroughly reviewed before deciding on surgery.

Are there countries where the uvulas are removed partially or completely as a part of the culture?

Yes, in some cultures, especially in Africa, the uvula is removed or trimmed as part of their tradition. [14-19]

When is surgery of the uvula recommended?

Uvula surgery planning showing the place that it will be cut (shown in black dashes) between the two black arrows. CamachoMD.com
Uvula surgery planning showing the place that it will be cut (shown in black dashes) between the two black arrows.

Surgery might be recommended for:

  • Growths (to remove the tissue and obtain a diagnosis),
  • Significant swelling such as during a bad infection (abscess),
  • A long and wide uvula (usually the surgery is performed to make the uvula smaller for snoring and/or obstructive sleep apnea).
The blue arrow is pointing to a papilloma (growth) on the uvula. CamachoMD.com
The blue arrow is pointing to a papilloma (growth) on the uvula.

A link to a post on this website to learn about uvula surgery can be found here:

https://surgery.fm/uvula-surgery

What is the ICD-10 Code for abnormalities of the uvula?

Hypertrophy of the uvula is K13.79.

Government Disclaimer: The views expressed in this website are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

References:

1.            Park, S.K., et al., The effects of uvulopalatal flap operation on speech nasalance and the acoustic parameters of the final nasal consonants. Auris Nasus Larynx, 2018. 45(2): p. 311-319.

2.            Shin, S.H., M.K. Ye, and C.G. Kim, Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: resection of the musculus uvulae. Otolaryngol Head Neck Surg, 2009. 140(6): p. 924-9.

3.            Girgis, I.H., Blood supply of the uvula and its surgical importance. J Laryngol Otol, 1966. 80(4): p. 397-402.

4.            Cho, J.H., et al., Arterial supply of the human soft palate. Surg Radiol Anat, 2017. 39(7): p. 731-734.

5.            Jerrard, D.A. and J. Olshaker, Simultaneous uvulitis and epiglottitis without fever or leukocytosis. Am J Emerg Med, 1996. 14(6): p. 551-2.

6.            McNamara, R. and T. Koobatian, Simultaneous uvulitis and epiglottitis in adults. Am J Emerg Med, 1997. 15(2): p. 161-3.

7.            Rapkin, R.H., Simultaneous uvulitis and epiglottitis. Jama, 1980. 243(18): p. 1843.

8.            Schwartz, R.H., Acute uvulitis and epiglottitis. Arch Otolaryngol Head Neck Surg, 1986. 112(7): p. 784.

9.            Shomali, W. and K. Holman, Concurrent uvulitis and epiglottitis. Cleve Clin J Med, 2016. 83(10): p. 712-714.

10.          Short, D.G. and D.S. Kitain, Acute uvulitis in combination with acute epiglottitis: a case presentation. Ear Nose Throat J, 1991. 70(7): p. 458-60.

11.          Westerman, E.L. and J.P. Hutton, Acute uvulitis associated with epiglottitis. Arch Otolaryngol Head Neck Surg, 1986. 112(4): p. 448-9.

12.          Feka, P., et al., Prevalence of bifid uvula in primary school children. Int J Pediatr Otorhinolaryngol, 2019. 116: p. 88-91.

13.          Chang, E.T., et al., The relationship of the uvula with snoring and obstructive sleep apnea: a systematic review. Sleep Breath, 2018. 22(4): p. 955-961.

14.          Adebola, S.O., et al., Profile of pediatric traditional uvulectomy in North-West Nigeria: The need for caution and education. Int J Pediatr Otorhinolaryngol, 2016. 88: p. 194-8.

15.          Farouk, Z.L., et al., Factors Influencing Neonatal Practice in a Rural Community in Kano (Northern), Nigeria. J Trop Pediatr, 2019.

16.          Hunter, L., Uvulectomy–the making of a ritual. S Afr Med J, 1995. 85(9): p. 901-2.

17.          Lowe, K.R., Severe anemia following uvulectomy in Kenya. Mil Med, 2004. 169(9): p. 712.

18.          Mbusa Kambale, R., et al., Traditional uvulectomy, a common practice in South Kivu in the Democratic Republic of Congo. Med Sante Trop, 2018. 28(2): p. 176-181.

19.          Miles, S.H. and H. Ololo, Traditional surgeons in sub-Saharan Africa: images from south Sudan. Int J STD AIDS, 2003. 14(8): p. 505-8.