Caldwell-Luc Operation

Caldwell-Luc operation is a process of opening the maxillary
antrum through canine fossa by sublabial approach
and dealing with the pathology inside the antrum.
Indications
1. Chronic maxillary sinusitis with irreversible changes
in the sinus mucosa.
2. Removal of foreign bodies or root of tooth.
3. Dental cyst.
4. Oroantral fistula.
5. Suspected neoplasm in the antrum and its biopsy.
6. Recurrent antrochoanal polyp.
7. Fracture of maxilla or blow-out fractures of the orbit.
8. As an approach to ethmoids (Horgan's transantral
ethmoidectomy) .
9. Approach to pterygopalatine fossa for ligation of
maxillary artery.
10. Vidian neurectomy.
Contra indications
Patient below 17 years of age.
Anaesthesia
General anaesthesia with cuffed endotracheal tube and a
pharyngeal pack. Can be done under local anaesthesia.
Position
Reclining with head-end of the table raised. Patient lies
supine with face turned slightly to the opposite side.
Technique
1. Incision. A horizontal incision with its ends upward
is made below the gingivolabial sulcus, from lateral incisor
A
to the 2nd molar (Fig. 82.1). It cuts through mucous
membrane and periosteum.
2. Elevation of flap. The mucoperiosteal flap is raised
from the canine fossa to the infraorbital nerve avoiding
injury to the nerve .
3. Opening the antrum. Using cutting burr or gouge
and hammer, a hole is made in the antrum. Opening is
enlarged using Kerrison's punch.
4. Dealing with pathology. Once maxillary antrum
has been opened, pathology is removed. Diseased antral
mucosa can be removed with elevators, curettes and
forceps. Cyst, benign tumour, foreign body or a polyp is
removed .
5. Making nasoantral window. A curved haemostat
is pushed into the antrum from the inferior meatus and
then this opening is enlarged with Kerrison's and sidebiting
forceps to make a window, 1.5 cm in diameter.
6. Packing the antrum. Rihhon gauze. impregnated
with liquid paraffin or Furacin ™ (Furacin ™ is 0.2% w/w
nitrofurazone) ointment can be packed in the antrum
and its end brought out from the nasoantral window into
the nose. Intrasinus packing is done if there is severe
bleeding. Pack is also kept in the nose.
7. Closure of wound. Sublabial incision is closed
with one or two catgut sutures.
Post-operative Care
1. Ice packs over the cheek in the fi rst 24 hours prevent
oedema. haematoma and discomfort to the patient.
2. Packing in the sinus and nose can be removed in
24-48 hours.3. Antibiotics are given for 5-7 days.
4. Patient should avoid blowing his nose for 2 weeks to
avoid surgical emphysema.
Complications
1. Post-operative bleeding. This can be controlled by
nasal pack.
2. Anaesthesia of the cheek due to stretching of
infraorbital nerve. It may last for a few weeks or
months.
3. Anaesthesia of teeth.
4. Injury to nasolacrimal duct.
5. Sublabial fistula .
6. Osteomyelitis of maxilla (rare).