Caldwell Luc Surgery
Caldwell Luc Surgery, also known as Caldwell-Luc antrostomy, and Radical antrostomy is a type of surgery that is performed to remove irreversibly damaged mucosa of the maxillary sinus.
Some facts about Caldwell Luc Surgery:
- The canine fossa is a depression on the anterior surface of the maxilla below the infraorbital foramen and is larger and deeper than the incisive fossa.
- Caldwell Luc Surgery is done when maxillary sinusitis is not cured by medication or other non-invasive technique.
- An external approach is used for surgical treatment of the severely diseased maxillary sinus.
- The surgeon entered the maxillary sinus from two separate openings, one in the canine fossa to gain access to the antrum and other in the naso antral wall for drainage.
- Caldwell Luc Surgery is an alternative to middle meatal antrostomy done through endonasal endoscopic surgery.
- Patients with an extensive maxillary disease, particularly those with massive polyposis or fungal disease undergoes Caldwell Luc Surgery.
- Recurrent nasal obstruction is the most common complication of Caldwell Luc Surgery.
- Recurrent sinusitis, recurrent polyposis, facial numbness, facial asymmetry, wound dehiscence, oro-antral fistulae, dacryocystitis and devitalised teeth are some of the other complications of Caldwell Luc Surgery.
- Caldwell Luc Surgery is done to treat chronic damage of cavity of maxilla bone, removal of foreign bodies, malignancy of sinus, fracture of maxilla and/or orbital floor, abnormal growth of mucous membrane of sinus, dental cyst, for management of hematoma or hemorrhage in the maxillary sinus and to treat fractures involving floor of the orbit or anterior maxillary sinus wall.
Procedure for Caldwell Luc Surgery:
- Caldwell Luc Surgery is done to remove infection and to strip diseased mucosa from the maxillary sinus
- Lidocaine-epinephrine solution is injected into gingivobuccal sulcus, and vasoconstrictor-soaked pledgets are placed in nasal cavity under general anesthesia.
- A small cut is made between the upper lip and gum and a bony window is made in the anterior wall of the maxillary sinus which gives access to the maxillary sinus.
- An incision will be made in gingivobuccal sulcus above canine fossa. This incision will be continued through periosteum, which is then elevated superiorly.
- The infraorbital nerve will be identified and window cut will be made into maxillary antrum with osteotome.
- The window will be enlarged by using punch forceps.
- Antrostomy will be created by passing curved hemostat into sinus under inferior nasal concha.
- Maxillary sinus will be visualized through both windows and debridement commences.
- At last gingival incision will be closed with absorbable sutures.
- Antrostomy should be created at least 1 cm posterior to anterior edge of inferior concha to avoid damage to nasolacrimal duct.
- Incision should be made above secondary dentition in children.
- CT or even plain radiographs can be used for visualization to avoid injury.
- Ice packs can be applied to the cheek to reduce oedema and discomfort.
- Blowing the nose should be avoided to prevent surgical emphysema.
- The nose should be irrigated with saline if an inferior meatal antrostomy has been done.
- Inserting an upper denture should be avoided for 7-10 days to allow the gingivolabial incision to heal and to avoid an oroantral fistula
