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.
- 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.
- Age: Not performed in patients below 17yrs as developing tooth buds in that region, may be damaged.
- Acute infection.
- Other systemic causes contraindicating surgery.
A semilunar incision is placed on the muvobuccal fold.
- 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.
- An opening is made in the medial wall in the lowermost and anterior aspect of the inferior meatus.
- 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.
- 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.
- Damage to Infraorbital Nerve.
- Damage to Orbital content.
- Reactionary Hemorrhage
- Recurrence of lesion.
- Antrostomy opening may get occluded.
- Textbook of Oral & Maxillofacial Surgery, Chitra Chakravarthy (2nd Edition)