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