Caldwell-Luc surgery, Caldwell-Luc operation, also known as Caldwell-Luc antrostomy, and Radical antrostomy, is an operation to remove irreversibly damaged mucosa of the

maxillary sinus The pyramid-shaped maxillary sinus (or antrum of Highmore) is the largest of the paranasal sinuses, and drains into the middle meatus of the nose through the osteomeatal complex.Human Anatomy, Jacobs, Elsevier, 2008, page 209-210 Structure It i ...

. It is done when maxillary

sinusitis Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, head ...

is not cured by medication or other non-invasive technique. The approach is mainly from the anterior wall of the maxilla bone. It was introduced by George Caldwell (1893)and Henry Luc (1897). The maxillary sinus is entered from two separate openings, one in the canine fossa to gain access to the antrum and other in the naso antral wall for drainage.

Medical uses

*Chronic damage of cavity of maxilla bone. *Removal of foreign bodies.Scott-Brown's otolaryngology, head and neck surgery * Malignancy of sinus. *Fracture of maxilla and/or orbital floor. *Abnormal growth of mucous membrane of sinus ( polyp). *Dental cyst. *For management of hematoma or hemorrhage in the maxillary sinus *To treat fractures involving floor of the orbit or anterior maxillary sinus wall (transantral repair)

Contraindications

It is rarely done in children as damage to secondary dentition may occur.

Complications

*Bleeding after surgery *Facial asymmetry *cheek discomfort *Damage to teethEarly Practice: External Sinus Surgery and Procedures and Complications.Otolaryngologic clinics of North America

Procedure

Anaesthesia

The operation may be performed under local

anaesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), a ...

but it is commonly carried under general anaesthesia. The use of topical anaesthesia and injection of

adrenaline Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands an ...

into soft tissue of

canine fossa In the musculoskeletal anatomy of the human head, lateral to the incisive fossa of the maxilla is a depression called the canine fossa. It is larger and deeper than the comparable incisive fossa, and is separated from it by a vertical ridge, the ...

is recommended.

Technique

First, the incision is made from lateral incisor to the second molar tooth. Then the flap of mucosa and

periosteum The periosteum is a membrane that covers the outer surface of all bones, except at the articular surfaces (i.e. the parts within a joint space) of long bones. Endosteum lines the inner surface of the medullary cavity of all long bones. Structu ...

is elevated and dissected to expose the anterior wall of sinus and then anterior wall is opened in the canine fossa where the bone is relatively thin with the drill. The opening can be enlarged by hayek or kerrison punch forceps to produce hole sufficiently large to provide access for example to allow removal of sinus mucosa or introduction of an

endoscope An endoscope is an inspection instrument composed of image sensor, optical lens, light source and mechanical device, which is used to look deep into the body by way of openings such as the mouth or anus. A typical endoscope applies several modern t ...

and instruments. Kerrison punch 02

The entire lining of sinus is dissected and removed as the success of the operation in

chronic rhinosinusitis Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, heada ...

. Packing of nasal cavity and sinus is sometime required. Suturing of buccal incision is recommended with absorbable suture material. The patient should be advised against overenthusiastic blowing of the nose for at least a week.

History

It was described by George Caldwell in 1893 and Henry Luc in 1897. They describe the operation of maxillary sinus diseases via

. Functional endoscopic sinus surgery is the standard surgery for maxillary

nowadays.

References

{{reflist Nose surgery Sinus surgery