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 its 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) fiber optic 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.

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 Jeffrey’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 without 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.