Caldwell-Luc Operation

Definition:

It is a radical operation in the maxillary sinus performed through the oral vestibule.

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Indications:

1. Inflammatory Condition: ex. Chronic Maxillary Sinusitis.

2. Cystic Condition: ex. Removal of Antral Polyps and Cysts & Antro-Choanal polyps

3. Neoplastic Condition: Benign and Malignant Lesions.
A. Benign lesion:
· Odontogenic: Ameloblastoma & Adenomatoid Odontogenic Tumor.
· Non-Odontogenic: Osteoma & Polyp.
B. Malignant Lesion:
· Squamous Cell Ca
· Minor salivary Gland Tumor
· Adenoid Cystic Ca

4. Miscellaneous:
· Removal of any root fragments or, Antrolith
· Zygomatico-maxillary fracture involving the floor of the orbit & anterior wall of maxillary sinus
· Management of hematoma in the maxillary sinus· Closure of mouth-sinus communications (oro-antral fistulæ)
· Removal of antral mucocœles
· A route to the ethmoid and sphenoid sinuses.
· Visualisation of the orbital floor for decompression.
· Vidian (nerve of the Pterygoid Canal) neurectomy.
· Access to the pterygo-maxillary fossa (the space behind the maxillary sinus).

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Contraindications:
1. Not performed in patients below 17 years of age as there may be damage developing tooth bud in that region.
2. Acute Infection.
3. Systemic Diseases.

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Technique / Procedure:

1. Anesthesia: GA preferred.
2. Incision of anterior wall of maxilla especially over the canine fossae, the incision should be semi lunar or, U shaped.
3. Removal of bone & window creation, the breadth of the window should be not less than the diameter of an index finger.
4. With the help of a periosteal elevator & curator, the whole lining of the antrum will be excised along with the lesion (depending upon the type of lesion, fresh bone may need to cut
5. Debridement.
6. Irrigation with normal saline.
7. Drainage by naso antral tube, this is called antrostomy
8. Sometimes ribbon gauze impregnated with antibiotic solution or, paste is placed & removed gradually (within -5 days) to facilitate healing.

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Another Technique: (Endoscopic Entry):

1- First an opening is punched from the mouth into the maxillary sinus with a special instrument.
2- The surgical instruments can then be passed through this opening.
3- Then the endoscope is passed into the maxillary sinus via the nose so that the operator can obtain a good overview of the sinus.
4- Altered mucosa is removed by means of the instrument which is inserted in the maxillary sinus via the opening in the mouth.
5- In addition the opening of the sinus to the nose is enlarged in order to allow for better ventilation since this promotes the postoperative healing of the sinus.

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Complications:

Common Complications:

1- Facial swelling
2- numbness of the face (infra-orbital neurapraxia). This is numbness of the cheek and not weakness, which always occurs temporarily but rarely persists.
3- numbness (temporary / permanent) of the upper teeth and the associated Gingivae.

Less Common Complications:
1- Oro-Antral Communication / Fistula)
2- Post-Operative Nosebleeds (Epistaxis)
3- Overflow of Tears (Epiphora) due to blockage of the tear duct.
4- Tooth root injury leading to tooth death (Devitalisation) & Tooth Discoloration

Rare Complications:
1- Facial asymmetry due to persistent facial swelling.
2- Prolonged Maxillary Sinusitis.
3- Post-Operative bleeding from the sinus / nose requiring packing of the sinus / nose or even a blood transfusion.
4- Infection of the Naso-Lacrimal Sac (Dacryocystitis)
5- Post-Operative hypersensitivity or 'Burning’ pain over the cheek, Gingivae or teeth. (hypæsthesia / dysæsthesia of the Infra-Orbital Nerve).
6- Blindness (if the eye socket is entered) & reduced sharpness of vision & movement of the eye (ocular dysfunction).

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Medication:

Analgesic, Antibiotic, Anti-Histamin and Corticosteriods.

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This Article has been Authored By :: World Of Dentistry :: TEAM
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:: World Of Dentistry :: TEAM