1. Introduction
3. Instruments required
5. Operative Procedure
7. Complication
8. Conclusion
9. References
Introduction
antrostomy. This procedure was named after george caldwell & Henri luc.
It was first developed by George cald well in 1893 from Newwork in 1897 Henri Luc
from Paris also reported the same procedure on his own Until the advent of
endoscope, it was the primary approach used for accessing the maxillary sinus. The
maxillary sinus and an opening for irrigations after closure of gingivobuccal sulcus
incision.
The benefits of cald well luc procedure, compared with intranasal antrostomy, are
better visualization of antral disease removal of all disease and creation of window for
permanent drainage.
Today, the cald well luc procedure combined with endoscopic approach also be
1) Removal of tooth or root from the antram that has been accidently pushed up
during course of extraction and removal through the socket could not be
achieved.
2) Removal foreign bodies like antrolithis from the sinus.
3) Chronic maxillary sinusitis where the removal of the lining of the antrum is
desired.
4) For removal of cyst from the antrum.
5) For removal of any benign growths of the maxillary sinus.
6) For control of any active haemorrhages following trauma of maxillary sinus.
7) For lifting floor of the orbit in case of blow out fracture.
8) For removal of an impacted maxillary canine or third molar that is mis directed
Contra Indication
2) Acute infection
3) Systemic diseases
Instruments Required
Retractors
Nasal speculum
Periosteal elevator
Gouge
Nasal trocar
Kerrison or back biting forceps
Rougeurs
Antral rasp
Antral curettes
The patient with maxillary sinusitis should be hospitalized. Bead rest and nutritious
Anatomy
Cald well luc operation incision is made in the anterior wall of maxilla especially over
the canine lossae. As the maxillary sinus is housed in the body of the maxilla, with
inferior orbital wall as the superior border lateral wall as the medical boundary
alveolar process of the maxilla as inferior border and canine fossa as the anterior
border.
Operative Procedure
Most surgeons prefer to undertake dental procedures before opening the antrum.
A local anesthetic with adrenalin may be infilterated below the oral mucosa on
margin and back to the second molar. In identilose cases, it is carried to and
introduction of atleast the index finger. The finger is used to palpate the tining
of the sinus.
Blood and pus contained in the sinus are removed by means of the aspirator.
used to illuminate the antral walls. It facilitates inspection of the contents of the
sinus and helps to determine state of the membrane lining it. This method helps
to find out the foreign bodies such as cotton or strips or gauge etc. pushed in
their big size because the usually lie in the post. Wall beneath the antral mucosa,
which however may bulge out they can be removed only after and incision is
tooth has been the cause of the infection or if a perforation had bene made while
extracting a tooth.
If a root has been forced into the sinus, a probe may be inserted into the socket
to help locate it, since often the root is covered by tissue and remains attached
should be allowed to fill with healthy blood clot, and finally, gingival margins
inserted into the nose at the beginning of the operation to prevent excessive
bleeding.
Nasal antrostomy is performed by introducing a nasal rasp through the nostril
below the inferior turbinate bone. It enters the sinus when force is applied by
moving the rasp back and forth an oblong aperature can be created for drainage
of the cavity.
In a more refined procedure for cutting the window nasoantral bone is removed
with an osteotome, and the nasal mucosa is cut on three sides, leaving it attached
only at the floor of the nose so that it can be folded into the antral cavity.
Any oozing of blood is arrested with adrenaline packs.
A long strip of plain or idoform tape saturated with petrolatum is inserted next.
This generally takes care of minor haemorrhages. End of the tape is pulled
through the nasoantral wall and the nostril since it is to be taken out from the
nose. It should be carefully folded into the antral cavity to facilitate removal.
Finally mucoperiosteal flap is replaced and incision is closed with interrupted
sutures.
Post Operative Treatment
Future Care
patients, whereas in other cases morpplune (1/4 gr) may be given 20 minutes
Common Complications
Facial swelling
Numbness of the face (infraorbital neurapraxia). This is numbness of check and
Oro-antral communication/fistula
Post-operative nose bleeds (epistaxis)
Overflow of tears (epiphora) due to blockage of the tear duct.
Tooth root injury leading to tooth death & tooth discoloration
Rare Complication
The caldwell-luc operation was first described in the late 19th century as a technique to
remove infection and disease mucosa from the maxilllary sinus via canine fossa,
while creating intranasal counter drainage, through the inferior meatus. The operation
has been performed countless time over the past 20 yrs. This critism is mublifactorial.
improve and endoscopic sinus surgery techniques has proven to be safe and effective
retrospetictive studies have shown high complication rales with the operation. Recent
studies have illustrated both the histologic benefit of complete removal of diseased
mucosa as well as better patient outcome with minimal morbidity when a safer
Overall, the cald well luc procedure is safe and effective as described and should