Caldwell-Luc Procedure

George Caldwell (New York)(1893)

Described a method of gaining space on maxillary sinus via canine fossa with nasal antrostomy.

Henric Luc (Paris)(1897)

Reported the same procedure as his own.

Thus a procedure by which the antrum is entered intraorally through the anterior wall & all irreversible disease is removed.

It is followed by antrostomy to promote permanent cure.

INDICATIONS:

  • Chronic Maxillary sinusitis.
  • Removal of foreign bodies in the antrum,such as root apices.
  • Treatment of benign dental cyst & tumours.
  • Treatment of Oro-antral fistula,that fails to heal.
  • Biopsy procedure for a suspected malignancy in the antrum.
  • Recurrent antrochoanal polyp.
  • Approach to Pterygopalatine fossa, Sphenoid sinus, Ethmoidal sinus.

CONTRAINDICATIONS:

  • Age: Not performed in patients below 17yrs as developing tooth buds in that region, may be damaged.
  • Acute infection.
  • Other systemic causes contraindicating surgery.

PROCEDURE:

1. Incision:

A semilunar incision is placed on the muvobuccal fold.

2. Exposure:

  • A Full thickness mucoperiosteal flap is reflect extending upto the intraorbital nerve.
  • Care is to be taken to protect the intraorbital nerve.

3. Approach to Antrum:

  • A micromotor with a large round bur is used to create a window about 1.5 to 2 cm in the anterior wall of antrum.
  • Sinus mucosa is seen below the bone.

4. Antral Lesion:

  • The lesion may be excised.
  • A biopsy may be done/sinus mucosa may be removed with the help of a currette if the case demands for it.

5. Antrostomy:

  • An opening is made in the medial wall in the lowermost and anterior aspect of the inferior meatus.

6. Packing:

  • The sinus cavity may be packed in with ribbon guaze impregnated with vaseline .
  • Guaze is packed in layers & the free end is brought out through created antrostomy opening.

7. Sutures:

  • Bone margins are smoothened.
  • The flap is replaced.
  • Flao may be sutured using resorbable suture material.

POST OPERATIVE CARE:

  • Ice packs are placed over the cheek for the first few hours after the surgery.
  • Sinus pack to be removed after 24-48 hours.
  • Avoid blowing nose for the at least 2-4 weeks after surgery.

COMPLICATIONS:

1. Intra-Operative:

  • Bleeding
  • Damage to Infraorbital Nerve.
  • Damage to Orbital content.

2. Post-Operative:

  • Reactionary Hemorrhage
  • Infection
  • Recurrence of lesion.
  • Antrostomy opening may get occluded.

REFERENCES:

  • Textbook of Oral & Maxillofacial Surgery, Chitra Chakravarthy (2nd Edition)
  • WorldofDentistry.com

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