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J J Zappia

Publications and source records attributed to J J Zappia.

At least 19 recordsLinked to original sources
PubMed1997

Pitfalls in the diagnosis of hemifacial spasm.

Hemifacial spasm (HFS), a condition characterized by involuntary unilateral facial spasms, is a disabling disorder resulting in functional compromise, patient frustration, cosmetic deformity, and social embarrassment. Compression of the seventh nerve at the root entry zone via vascular loop is presently the most widely accepted causative theory. Although less common, there are other entities that can result in HFS. Basic evaluation, including a thorough history, physical examination, and magnetic resonance imaging (MRI) scan, is important to confirm the diagnosis and rule out other causes. The relation of vascular loop syndrome to HFS is well enough established that radiologic documentation of a vascular loop is probably not necessary in every case. Here we present 12 cases of HFS, 6 without VLS. The etiology and evaluation of HFS are reviewed.

Adult↗
PubMed1997

Rethinking the use of auditory brainstem response in acoustic neuroma screening.

The ability of magnetic resonance imaging (MRI) to detect very small acoustic tumors has triggered many to rethink the use of auditory brainstem response (ABR) in the screening of acoustic tumors. To assess ABR accuracy, we conducted a retrospective study of 388 surgically treated patients. Of these patients, 111 had complete databases including both preoperative MRIs and ABRs. The ABR was abnormal by wave V interaural latency difference in 106 (95%) of the cases. Although our overall sensitivity was 95%, sensitivity varied according to tumor size. ABR was abnormal or absent for all tumors (100%) larger than 2 cm in diameter, for 98% of tumors 1.1 to 2 cm in diameter, and for only 89% of tumors less than or equal to 1 cm in diameter. Ramifications of this in the decision-making process are presented. Criteria for cut-off values are also discussed.

Audiometry, Evoked Response↗
PubMed1996

Posterior semicircular canal occlusion for benign paroxysmal positional vertigo.

For the small group of patients with benign paroxysmal positional vertigo that does not resolve with time or conservative treatment measures, posterior semicircular canal occlusion is considered. In the past 2 years, eight patients have undergone posterior semicircular canal occlusion at the Chicago Otology Group. All patients noted resolution of their positional vertigo. No complications were observed, particularly no sensorineural hearing loss was noted. A several-week period of disequilibrium is typical and appears to be the most bothersome aspect of the surgery to the patient.

Adult↗
PubMed1995

Congenital cholesteatoma.

OBJECTIVE: To review the characteristics of congenital cholesteatomata. DESIGN: Case series. SETTING: Tertiary care (referral-based) private practice. PATIENTS AND OTHER PARTICIPANTS: Fourteen patients were included in the study. The diagnosis of congenital cholesteatoma was based on an intact tympanic membrane on physical examination; a history that excluded tympanic membrane perforation, otorrhea, or previous otologic procedure; and a documented cholesteatoma at the time of surgical removal. INTERVENTION: Surgical procedures including tympanotomy, atticotomy, and tympanotomy with mastoidectomy were performed on all patients. MAIN OUTCOME MEASURES: Removal of cholesteatoma. RESULTS: Four of the 14 patients had lesions isolated to the anterosuperior quadrant of the tympanum; the remainder had more extensive disease with notable posterior tympanic involvement. Three of the patients underwent surgery for recidivism; none were from isolated anterior lesions. One of these patients was referred at the time of recurrence, one had known residual cholesteatoma, and one had recurrence. CONCLUSIONS: Clinical presentation and surgical findings enable the differentiation of two separate sites of congenital cholesteatoma formation: the anterosuperior and posterior-superior regions of the tympanic cavity. Recidivism of the lesion appears more commonly with posterior-superior congenital cholesteatomas.

Adult↗
PubMed1995

Conservative management of patients with small acoustic tumors.

Of 432 patients referred for treatment of their cerebellopontine angle tumors, 53 with acoustic neuromas were managed initially without intervention but with adequate follow-up. Mean presenting tumor size in this subgroup of patients was 0.98 cm (range, 0.2 to 3.0 cm), and average growth rate was 0.16 cm per year. Twenty-one patients demonstrated tumor growth with a mean follow-up interval of 1.9 years. Of these 21 patients, 14 underwent microsurgical excision, 4 received radiation, 2 continued to be observed and 1 was lost to follow-up. The remaining 32 (60%) had no demonstrable growth with a mean follow-up of 2.13 years. Of these patients, 29 continue to be followed and 3 were lost to follow-up. Of the information evaluated, the only statistically significant relationship is with larger tumor size in elderly patients--most likely reflecting the propensity to opt for conservative treatment in elderly patients. Tumor growth rate was unrelated to presenting tumor size or patient age, which suggests that conservative treatment may be appropriate in selected patients.

Adult↗
PubMed1994

Intraoperative facial nerve monitoring: a description of a unique system.

Intraoperative facial nerve monitoring has become an integral adjunct in facial nerve identification and preservation for patients undergoing cerebellopontine angle surgery. Since the first description of EMG monitoring of facial nerve activity intraoperatively, many systems have been developed. These systems often rely on unilateral monitoring of the facial nerve with auditory feedback to the surgeon, and it is difficult to distinguish between artifact and significant stimulation of the facial nerve. In this paper, we present the use of a bilateral, multialarm, facial nerve monitoring system that has multiple advantages over previous systems. Furthermore, we review our experience with this bilateral system, comparing a group of 50 monitored patients to a group of 50 unmonitored patients.

Adolescent↗
PubMed1994

Selective embolization of glomus jugulare tumors.

Four patients with grade C or D(1) glomus jugulare tumors who underwent preoperative highly selective embolization followed by infratemporal fossa removal of their tumors were compared to three patients undergoing surgery alone with respect to intraoperative blood loss, operative time, cranial nerve palsy, length of hospitalization, and perioperative complications. Embolized patients demonstrated a marked reduction in blood loss (650 vs 1375 cc) compared with the nonembolized group. Operative time was shortened (by 51 minutes). Facial nerve function did not appear related to embolization but was directly related to intraoperative nerve manipulation. Hospital stay, perioperative complications, and lower cranial nerve palsies were not related to embolization.

Journal Article↗
PubMed1994

Congenital aural atresia.

Congenital aural atresia is an unusual anomaly that is difficult to surgically correct. Altered anatomical landmarks, especially of the facial nerve, and variability of the middle ear configuration, contribute to the difficulty of the procedure. In addition, the unpredictable healing process can make for variable outcomes. Choosing appropriate candidates for surgical repair minimizes risks and enhances patient care. This report reviews the outcome with evaluation and management of 17 patients with congenital aural atresia. Surgical techniques for repair, including use of a hydroxylapatite canal wall prosthesis to help reconstruct the posterior canal wall are described. As expected, patients with less severe anomalies had better postoperative hearing results. Lateralized tympanic membrane, canal stenosis, and meatal narrowing were complications encountered. The anatomy and embryology of the ear and facial nerve are reviewed to assist surgeons in safe, successful surgery.

Adolescent↗
PubMed1993

Titration streptomycin therapy in Menière's disease: current concepts.

Soon after its discovery, streptomycin sulfate was found to be beneficial in the treatment of tuberculosis. However it also was found to have toxic effects, primarily vestibular and typically sparing the auditory nerve until higher doses were administered. The first reported use of streptomycin in the treatment of vertigo was in 1948. This was soon followed by its use for treating Menière's disease. Although excellent control of vertigo was achieved significant post-treatment oscillopsia was experienced by these completely ablated patients. A protocol of titration streptomycin therapy was established that effectively controls vertigo while decreasing the incidence of oscillopsia. This report presents three patients with Menière's disease treated with this protocol.

Adult↗
PubMed1993

Branchiogenic carcinoma.

The validity of the diagnosis 'branchiogenic carcinoma' has been debated for many years. Recently, Micheau, et al recorded 21 cases of metastatic squamous carcinoma that presented with cystic masses in the neck and concluded that most, if not all of the reported cases of branchiogenic carcinoma, were in fact of similar origin. This report contains histological evidence of the origin of squamous cell carcinoma from a branchiogenic cyst in an otherwise healthy young man. Five similarly convincing reports from the literature are also reviewed.

Adult↗
PubMed1992

Cervical metastatic glioblastoma multiforme.

Glioblastoma multiforme is an anaplastic neoplasm of glial origin. In spite of the aggressive histologic features and poor prognosis, metastasis outside the cranial vault is distinctly unusual. A patient with glioblastoma multiforme metastatic to the neck is presented. We also review the topic of metastatic intracranial tumors.

Adult↗
PubMed1992

Signet-ring cell adenocarcinoma metastatic to the maxillary sinus.

Signet-ring cell variant is a rare type of adenocarcinoma that has been reported in the paranasal sinuses and in other areas, most commonly the gastrointestinal tract. We describe a patient with signet-ring cell adenocarcinoma of the maxillary sinus who had dental and facial pain. Further evaluation revealed that the lesion was metastatic from an esophageal primary lesion. The unusual nature of this cell type and the importance of careful evaluation to exclude the possibility of these lesions representing metastatic lesions is discussed.

Adenocarcinoma, Mucinous↗
PubMed1992

Mucoepidermoid carcinoma associated with acute lymphoblastic leukemia.

As treatment and survival of acute leukemia as well as other types of pediatric cancer improve, the number of second malignancies in these treated patients will increase. Occurrence of these second malignancies in the head and neck is not frequently reported although it is known that radiation treatment, chemotherapy and sometimes the primary lesion itself are risk factors for neoplasia. Malignancies of the parotid gland in the pediatric population are known to be unusual. We discuss a mucoepidermoid carcinoma in a 10-year-old female who 7 years earlier had undergone successful treatment of acute lymphoblastic leukemia.

Carcinoma↗
PubMed1992

Olfactory neuroblastoma associated with Kallman's syndrome.

Kallman's syndrome is an unusual clinical entity that includes anosmia and hypogonadotropic hypogonadism. We present a patient in whom an olfactory neuroblastoma was discovered during evaluation of his Kallman's syndrome. While other craniofacial abnormalities have been associated with this condition, to our knowledge this is the first report of its association with olfactory neuroblastoma.

Adolescent↗
PubMed1991

Primary adenocarcinoma of the temporal bone. A case with 40-year follow-up.

Adenomatous tumors of the temporal bone are rare neoplasms. This article records the 40-year course of a patient with adenocarcinoma of the temporal bone and reviews the literature pertinent to the biologic behavior, histologic appearance, prognosis, and treatment of this group of tumors.

Adenocarcinoma↗
PubMed1991

Evaluation of the temporal bones of a multichannel cochlear implant patient.

In this report we detail the temporal bone findings of a 57-year-old patient who underwent placement of a Nucleus 22-channel electrode 7 months prior to his death. Audiometric testing postoperatively demonstrated suprasegmental speech cue discrimination only. Histologic evaluation of the cochleas revealed significant sensorineural survival except in the region of the basal turn of the implanted cochlea adjacent to the implant. There was no significant pathologic condition attributable to the operation or the electrode in areas remote from the basal turn of the cochlea.

Audiometry, Pure-Tone↗
PubMed1991

Palatal inclusion cyst: an unusual complication of uvulopalatopharyngoplasty.

Inclusion cyst formation after uvulopalatopharyngoplasty has not been previously reported. We describe a case of postoperative inclusion cyst in a 62-year-old man who presented with recurrent obstructive sleep apnea symptoms. Simple transoral excision of the cyst was curative. Careful eversion of the mucosal edges at the time of the original palatal surgery may have prevented this problem from occurring.

Cysts↗