Sinus Surgery Ends 10 Years of Problems
Sinus problems and sleep apnea won’t slow down this politician anymore, thanks to Riverview Medical Center’s new infrared image-guided computer system.
There are plenty of things that can keep a busy executive and legislator up nights. But Joseph Azzolina’s problem wasn’t on his mind, but rather in his head – literally. The District 13 Assemblyman and president of Food Circus Supermarkets (Foodtown) had been plagued by chronic sinus problems for over 10 years. Coping with a persistent cough, postnasal drip, facial pressure, and breathing difficulties had become a way of life for him, and previous surgeries to correct the problems were only partially successful. Even aggressive medical therapy did not work. In recent years, Joe also began to experience an increase in snoring at night and fatigue during the day. “I was coughing constantly – all day and night – and I couldn’t get rid of it,” he says. “It was really keeping me up at night.” Eventually, he underwent a sleep study, where a technician monitored him during his sleep to help identify the cause of his symptoms. The results indicated that he had obstructive sleep apnea.
A Common Sleep Disorder
Sleep apnea is the most common sleep disorder, affecting over 12 million Americans, according to the National Institutes of Health. Many people feel that an inability to get a good night’s sleep is a problem they just have to live with, but sleep apnea can cause far more serious health problems, such as high blood pressure and cardiovascular disease, memory problems, weight gain, and headaches. Accurately diagnosing the sleep apnea and undergoing appropriate treatment is extremely important.
Apnea, which is a Greek word meaning “without breath,” is a fairly accurate description of the condition because it causes a cessation of breathing for brief periods of time during sleep. Although there are three types of apnea – obstructive, central, and mixed – the most common is obstructive sleep apnea, which occurs when soft tissue at the back of the throat collapses and closes during sleep. The result is a blockage in the airway, which causes interrupted breathing and a poor quality of sleep. Over time, a continuing lack of sleep starts to affect a person’s ability to concentrate and stay awake during the day. Sleep apnea has even been linked to motor vehicle and on-the-job accidents.
The sleep study revealed that Joe had a dangerously high apnea index value of 56, meaning that while he slept, he was not breathing or, at most, breathing very shallowly, for at least 10 seconds, 56 times per hour. Frank Scaccia, M.D., an otolaryngologist (ear, nose, and throat specialist) affiliated with Riverview Medical Center, evaluated Joe and ordered a CT scan to determine the severity of Joe’s sinus condition. The scan confirmed that Joe also had persistent and significant disease with polyps and infection involving almost all of his major sinuses.
New Technology, Greater Accuracy
“Unfortunately, whenever there is scar tissue the risks of surgery become higher and the outcome becomes more unpredictable,” says Dr. Scaccia. “However, using Riverview’s new infrared image-guided computer system as a complement to our endoscopic approach, I was able to safely and effectively navigate through Joe’s sinuses and thoroughly clean out the disease.”
The entire sinus operation was done through Joe’s nose with no external incisions or post-operative swelling. In addition, specially designed straws were placed through the nose packing so that Joe could breathe through his nose right after surgery, even while the packing was in. In order to treat his snoring and sleep apnea, Dr. Scaccia also simultaneously performed an uvulopalatopharyngoplasty (UPPP), removing some of the excessive tissue in the back of Joe’s throat.
“What was great was that both the sinus problem and coughing were fixed during one successful surgery,” says Joe. “Dr. Scaccia and his surgical team made sure it was done right the first time, so I didn’t have to come back. And I can’t say enough about how wonderful the nurses were.”
After two days, the packing and straws were removed from Joe’s nose, and he was feeling much better. So much better, in fact, that he was immediately able to resume his legislative duties and made an appearance at the annual Middletown Firemen’s Picnic.
Now Sleeping Soundly
Six weeks later, Joe was almost totally healed and noted significant improvement in all of his previous symptoms, which included nasal congestion, daytime fatigue, coughing, snoring, and post-nasal drip. “Now I fall to sleep right away, and even if I have to get up for some reason, I can go back to sleep right away and sleep soundly,” adds Joe. “I’m very satisfied.”
To find an ear, nose, and throat specialist, call Meridian Physician Referral at 1-800-560-9990 or log onto Meridian’s Web site at www.meridianhealth.com.
More than a Case of the Sniffles
New technology on sinus at Meridian helps save a man with an unusual problem that was incorrectly diagnosed for years.
For almost three years, 38-year-old Jeffrey Robertson of Middletown had experienced an unusually persistent postnasal drip, a perpetually runny nose and headaches. He never went anywhere without a box of tissues; the problem was beginning to affect his life. A variety of physicians had diagnosed Jeffrey’s problem as everything from stress, to an infection, to a need for eyeglasses.
In November 1998, Jeffrey sought the medical expertise of Frank J Scaccia MD, a Riverview Medical Center ear, nose and throat specialist with a practice in Red Bank. After performing a nasal endoscopic exam, Dr Scaccia began to suspect that Jeffrey’s problem was more than an allergy or upper respiratory infection. In fact, he thought it may be a much more serious medical condition a cerebral fluid (CFS) leak.
A CT scan of Jeffrey’s sinuses and brain verified Dr Scaccia’s suspicions and further indicated that a large mass was either eroding into the sinuses from the brain or from the sinuses into the brain.
This was a very unusual presentation for a CFs leak since there was no proceeding event of trauma or surgery that would cause this, says Dr Scaccia. ‘‘Jeffrey was extremely lucky not to have developed neurological complications such as meningitis or a brain abscess considering the length of time this had been occurring.”
Riverview neurosurgeon Bruce Rosenblum MD, examined Jeffrey and his test results. Both physicians agreed that immediate surgery was necessary. Four days before Thanksgiving, Jeffrey was admitted to Riverview Medical Center for surgery.
High-Tech Surgery Close to Home
‘‘It was important for me to be at Riverview because it was close to home and my then 10-year-old daughter could visit everyday which she did,” explains Jeffrey. ‘‘Although I was confident in my physicians, we really didn’t know how the surgery would turn out and I wanted to be able to see her as often as possible. That was important to both of us.”
During the first part of the surgical procedure, called a bifrontal craniotomy, the herniated brain tissue was identified . This condition occurs when the brain tissues pushes into the sinuses and nose. Dr Rosenblum, with assistance of Dr Scaccia, separated a portion of the tissue that had decompressed into the sinus/nasal passages and restored the affected area with a section of the Jeffery’s own leg muscle. The second part of the surgery required Dr Scaccia to perform a septoplasty and endoscopic sinus surgery to remove the separated brain tissue from the nasal/sinus cavity.
One day after surgery Jeffrey was up and walking. Within just a few days he left Riverview Medical Center with out complications and or neurological consequences. Jeffrey says he feels like a new man. He has had no recurrence of the condition his breathing is better, his headaches are gone and he is back at work.
By SANDRA OTTO CUMMINGS
LEANING BACK in his chair relaxing after a workday at a chemical company, 60-year-old Donald Logan felt the hiccups starting. They’d been doing that since he was 18, but since1988, they had worsened–striking regularly and without warning for days at a time.
‘‘I can take a deep breathe; I can take a glass of water and they’d be there,‘‘ the Long Branch resident said. Logan knew what worked: Taking a toothbrush or the earpiece of his eyeglass frame, he would reach back in his mouth to gag himself. But late that night of Sept 4th ,as he plied the eyeglasses, a hinge snapped.
The 6-inch earpiece went sliding down his throat, setting off a medical marathon. It ended the next night at Riverveiw Medical Center, Red Bank, with an operation that ‘‘everyone at Riverveiw was talking about,” said Dr. Glenn Morganstern, Shrewsbury, Logan’s family doctor.
Dr. Frank J. Scaccia, the Red Bank ear. nose and throat specialist who removed the earpiece in a 15- minute procedure, has pulled a lot of objects out of windpipes. But the patients are usually 3-year-olds and the objects more commonly popcorn, beads, broccoli or bobby pins.
‘‘What’s so unusual about his case is here’s a grown man. Someone of this age and type (of object) is unusual,” he said.
Two-thirds of the eyeglass frame earpiece was in Logan’s left lung. Scaccia said, the rest still in his windpipe leading to the lungs.
‘‘It was very dangerous. He could have died from it,” Scaccia said. ‘‘It could have eroded the trachea (windpipe). He could have coughed it up and had it completely obstruct the airway.”
Logan didn’t get to Scaccia immediately. Realizing what happened. Logan said he dropped to his hands and knees as he tried to fish the piece from his throat–calling out to his daughter to call an ambulance. He went first to the emergency room at Monmouth Medical Center, Long Branch, where Logan said a nurse was able to grab the eyeglass piece with an instrument.
‘‘She had it,” he said. ‘‘She said she’d pull it out, but she wanted to wait for the doctor.”
But Logan said by the time the doctor arrived 20 minutes later, the ear piece had gotten away.
‘‘The doctor said, ‘‘It’s in your stomach. Don’t worry about it,” Logan said ‘‘It would pass out (through the intestines) in a day or so.”
Cathy Goetz, medical center spokeswoman, said no one at the hospital even saw the earpiece. The woman who treated Logan first was actually an emergency room doctor who sedated him and used the necessary equipment to look down Mr. Logan’s throat and saw nothing.”
She called an ear, nose and throat specialist “who looked down Mr. Logan’s throat with different equipment and saw nothing.”
By then, since Logan was‘‘ so much improved and the two examinations had shown nothing,” Goetz said,‘‘ the specialist concluded the supposed foreign body had passed into the patient’s stomach and therefore could not cause him any further respiratory distress.”
The next day, Logan said he still felt the piece inside. He’d cough and it would seem to rise in his throat, but he still couldn’t grab it. He went to Morgenstern, who sent him to Dr. Brian Boyle, a Red Bank specialist in treating digestive tract.
At Riverview, Boyle said he passed a scope down Logan’s throat to see whether the errant eyeglass piece was in the esophagus or stomach. In the windpipe, he saw a white area that looked like the target.
Boyle sent Logan to Scaccia, and he was in the operating room two hours later. With his patient anesthetized and attached to a ventilator providing oxygen to his lungs, Scaccia slipped a long tube called a bronchoscope between Logan’s vocal cords to locate the eyepiece.
Then Scaccia quickly replaced that and the breathing tube with a rigid 18-inch long bronchoscope. He slipped a long, thin, grasping forceps through the bronchoscope’s 1/2 inch diameter center to grab the inhaled eyeglass earpiece and withdraw it.
“ I had to make sure I didn’t drop it back and obstruct the airway,” Scaccia said.
Logan takes his experience in stride:
‘‘‘I roll with the punches and the hiccups,” he joked. He won’t change his way of relieving them.
‘‘It could happen again, but this time I’ll be more cautious.” he said–making sure he leans forward instead of back to grab himself and ‘‘use the toothbrush more.”
Scaccia had another idea ‘‘I told him to get contact lenses.”
FRANK SCACCIA WINS ABFPRS ANDERSON PRIZE
Frank J. Scaccia, MD, of Red Bank, NJ will receive the Jack Anderson Prize for Scholastic Excellence at the AAFBRS’ 1995 Fall Meeting in New Orleans. The award is given annually to the individual receiving the highest score on the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) examination that is given to surgeons completing an AAFPRS Foundation fellowship or applying for certification by the ABFPRS.
‘‘I feel obligated,” Dr. Scaccia says, ‘‘that if patients are trusting me with their appearance– that I should be prepared to offer them the highest quality care available. Attaining ABFPRS certification is one way of assuring both the patient and myself that I have this capability.
Dr. Scaccia practices facial plastic and reconstructive surgery as part of a three surgeon speciality group. ‘‘It is general otolaryngology practice, with an emphasis on rhinology,” he explains. ‘‘I do a lot of cosmetic procedures, but I also take on a fair amount of reconstructive work.”
After receiving his medical degree at Wake Forest University’s Bowman Gray School of Medicine in Winston -Salem, NC, Dr Scaccia completed a residency in otolaryngology at Case Western Reserve University. ‘‘The program provided me with excellent training in facial plastic surgery,” Dr. Scaccia says.‘‘I am grateful to Anthony J. Maniglia, MD the residency program chair and David W. Stepnik, MD, director of the facial plastic surgery division, for their support and encouragement.”
Saying he appreciates the efforts of everyone who had a hand in establishing and maintaining ABFPRS, Dr Scaccia adds that he plans to donate the $ 500 prize money to a charitable fund in support of medical education. The board exam, Dr. Scaccia concludes, is rigorous but well worth it. I learned a lot from the experience and I recommend it highly to everyone in the field.”
For an application for the 1996 ABFPRS, Suit 310, One Prince Street, Alexandria,VA22314; telephone (703) 549-3223; fax (703) 549-3557
Sea Bright resident scores high marks in surgery and athletics
By Vaughn Watson
Facial plastic and nasal sinus surgery are Frank J Scaccia’s specialties. So are racing bikes and running marathons. Suffice it to say, the Red Bank physician works and plays on the cutting edge.
Last June, Scaccia, won the 1995 Jack Anderson prize for scholastic excellence among physicians who took a national certifying examination. The test was for certification as a member of the American Board of Facial Plastic and Reconstructive Surgery. Scaccia’s score ranked him in the 99th percentile in both the written and oral sections of the exam. The board examination was a test of his mettle, he said.
For the oral section, he took himself to Washington, DC, sat down in a hotel room and was bombarded with 2 days of oral and written questions by a host of facial plastic surgery board directors.
‘‘The test was rigorous,” said the Duke University graduate and member of the scholastic honor society Phi Beta Kappa. ‘‘For 6 hours straight they would just drill you with questions.” He is now one of 10 board-certified physicians in the Garden State. Board certifications qualifies him to travel to Third World countries to teach what he knows to plastic surgeons there.
‘‘I feel obligated to offer my patients the highest quality care available,” Scaccia said of his reason for seeking the certification training.
‘‘By preparing for and obtaining certification I think I am able to provide them with the confidence they’ll need before undergoing surgery.”
One Physician at the Red bank office where Scaccia works echoed those sentiments. ‘‘All patients no matter what type of physician they see are concerned about training and the level of competency (of their doctor),” said Dr. Timothy P. Sullivan, a Little Sliver resident and former Monmouth County Medical Association president.
‘‘One of the reasons that we brought Dr Scaccia to the practice is that one of the segments of what doctors in our speciality do is facial plastic work.”
‘‘With (Scaccia) achieving the highest score in the country-the certification by the exam should reassure the patients that he has an extensive knowledge of facial plastic surgery and the various procedures and options available,” Sullivan said. Scaccia said that surgery is indeed an interest that consumes much of his life.
‘‘Many nights I just fell asleep either watching a video tape or reading a book (about medicine),” Scaccia said. ‘‘I just have a passion for it and not only is it my job, it is sort of my hobby.”
His patients include athletes who hope reconstructive nasal and sinus surgery will open up breathing passages and allow them to breeze past their competition.
‘‘ A big advantage I have is that I am trained to treat not only the headaches and sinus problems… but I also help patients look better.”
Other operations Scaccia performs include facial rejuvenation and aesthetic operations to remove unsightly growths, such as fat pockets around the eyes.
‘‘People are starting to realize that cosmetic surgery is not just for the Beverly Hills rich and famous.”
When he’s not working, the single Sea Bright resident usually can be found biking or riding his jet ski. ‘‘I jet ski the water in Sea Bright.”
As a youngster in Ocean Town ship, he joined the local Boy Scout troop and made Eagle Scout by 14.
That same year, he ran the Jersey Shore Marathon in 2 hours and 54 minutes. His time ranked him ninth in the nation for boys 15 and under. ‘‘I got better when it was 15 miles or longer,” he said of his competitive edge. ‘‘I made my name doing the longer distances.”
Scaccia continued to excel in cross-country and spring track as a student at Ocean Township High School. He has since traded his running flats for two tires and a bike frame. As a professional cyclist, he rode as a member of the Long Branch-based Atlantic Bike Club. He just finished a spring and summer racing season with Team Cleveland in Ohio. He said he also enjoys practicing his classical guitar. ‘‘I played it since I was 15.” But the tunes keep coming, even when Scaccia stops playing. He has been known to play the Rolling Stones in the office, he said. ‘‘In fact, some times anesthesiologists have to tell me to turn it down because they can’t hear the heart beat.”
US NEWS & WORLD REPORT
Feb. of 1998
Relief For Chronic Sinusitis Sufferers
Chronic Sinusitis is one of the most common health ailments in the United States, afflicting almost 40 million people in the country per year. Fortunately, most sinus attacks, which can include headaches, post nasal drip and nasal congestion, will subside with properly administered antibiotics, decongestants and steroid nasal sprays. However, because of anatomical problems that develop within the nose and failure of antibiotics to eradicate certain bacteria, the condition can occasionally be resistant to medical treatment and cause persistent symptoms that last for months or even years.
Much to the relief of these chronic sinus sufferers, a relatively new minimally invasive procedure is now available to potentially cure or at least dramatically improve the effects of this condition for many patients. Functional endoscopic sinus surgery (FESS for short) was introduced into the US in1985, but only recently has gain worldwide acceptance by ear, nose and throat physicians.
Dr Frank Scaccia, a board certified ear, nose and throat specialist in Red Bank, regularly performs this procedure and is a strong advocate of it’s usefulness on certain patients. ‘‘Although I have been using this technique for the past seven years, it is only in the last two or three years with the advent of new instrumentation of the sinus anatomy and physiology that I can really almost guarantee my patients significant relief of their symptoms.”
A review of 186 of Dr Scaccia’s patients who underwent sinus surgery during a two-year period revealed a 96 percent success rate. Complications in the study were minimal and easily controlled with no lasting effects. The ages of his patients undergoing FESS ranged from 4 to 75 years.
The operation is usually done entirely through the nose with lasers and a small diameter (4mm) fiberoptic scope that amplifies an image on a TV monitor. ‘‘Specially designed sinus instruments are introduced into the sinus cavity to remove infected tissues and open areas that have become blocked. Most patients go home the same day with usually no swelling and minimal packing,” explains Dr Scaccia who also reports that plans are underway to incorporate computer-guided imaging technology with FESS to further enhance results.
Because of his experience in this field, Dr Scaccia has been recently asked to report in his findings and techniques. He is publishing a book chapter on sinus and nasal surgery in a medical text to be published by WB Saunders in Philadelphia next year.
Despite excellent results, Dr Scaccia is quick to point out that the surgical procedure is not for everyone who suffers sinus problems. ‘‘An aggressive medical regimen with strong antibiotics is always a good first option,” he says.
In addition, Dr Scaccia is also certified by the American Board of Facial Plastic and Reconstructive Surgery and will often perform cosmetic surgery on the outer nose simultaneously with sinus surgery if the patient desires. Interestingly enough, the same scopes used for sinus surgery can also be used to help visualize and smooth the outer contour of the nose.
Facial Plastic Surgeon Specializes in Achieving Natural-Looking Results
‘‘ Patients should never look as if they have had plastic surgery. The results should be natural-looking. A careful understanding of the function of the underlying structures must also be taken into account,” explains Dr Scaccia whose medical practice concentrates heavily on the face and neck. In 1995, Dr Scaccia was honored by the American Board of Facial Plastic and Reconstructive Surgery after achieving the highest grade in the US on his board certifying exam. He hopes to use his knowledge to help further expand this exciting field.