Exodontia.Info
Caldwell-Luc Operation /
Intra-Oral Antrostomy
The Caldwell-Luc operation (in the Oral Surgical use of
the procedure) is used for the:




  • Reduction of facial fractures especially those involving
    the orbital floor


In the Ear, Nose & Throat sense, the
Caldwell-Luc
procedure is used for:

  • Treatment of chronic sinusitis

  • Removal of antral polyps and cysts & antro-choanal
    polyps

  • Removal of antral mucocœles

  • A route to the ethmoid and sphenoid sinuses

  • Visualisation of the orbital floor for decompression


  • Various forms of tumour surgery and

behind the maxillary sinus).

Having said this though, this procedure is dying a death as
Functional Endoscopic Sinus Surgery (FESS) is
superceding the
Caldwell-Luc procedure.  It is associated
with far less problems (as listed below).

As I have experienced, when patients are given the option
of either a
FESS or a Caldwell-Luc, most aptients opt for
a
FESS (understandibly).
The procedure can be carried out under Local Anaesthetic though it may be a
pleasanter experience all round for it to be carried out under
General Anaesthetic.

A small cut is made between the upper lip and gum and a bony window is made
(giving access to the
maxillary sinus) in the anterior wall of the maxillary sinus.

The natural opening of the sinus into the nasal cavity is often enlarged at the same
time to improve drainage of normal secretions and reduce the chance of recurrent
disease.

Occasionally, a new opening (
naso-antral window) is also created between the
nose and maxillary sinus.
This list of warnings might seem excessive to some however the legal ruling in
the case of
Chester vs Afshar (2004) would suggest that it is quite prudent /
necessary to list them.  Others might say that there isn't enough information but
where do you stop?

The following list of warnings regarding the
Caldwell-Luc operation is neither
exhaustive nor is it predictive.

These are the commoner risks. There may be other unusual risks that have not
been listed here.  Please ask your
Oral Surgeon if you have any general or
specific concerns.

Common Complications:

  • Facial swelling

  • Pain ± numbness of the face (infra-orbital neurapraxia).  This is numbness of
    the cheek and not weakness, which always occurs temporarily but rarely
    persists and

  • Pain ± numbness (temporary / permanent) of the upper teeth (incisors around
    to the bicuspids) and the associated gums


Less Common Complications:



  • Overflow of tears (epiphora) due to blockage of the tear duct and

  • Tooth root injury leading to tooth death (devitalisation) & tooth discoloration


Rare Complications:

  • Facial asymmetry due to persistent facial swelling attributed to scarring and
    thickening of the facial tissues (possibly due to escaped lymphatic fluid from
    the damaged lymphatic channels following excessive retraction of the cheek).

  • Prolonged maxillary sinusitis.

  • Post-op bleeding from the sinus / nose requiring packing of the sinus / nose or
    even a blood transfusion.



  • Blindness (if the eye socket is entered) & reduced sharpness of vision &
    movement of the eye (ocular dysfunction).



Useful Website & Article:

Australian & New Zealand Journal of Surgery 2008.  Complications Of The
Caldwell-Luc Operation And How To Avoid Them.

JOMS 2012.  Caldwell-Luc Operation without Inferior Meatal Antrostomy - A
Retrospective Study of 50 Cases


New York Eye & Ear Infirmary - ENT Academic Faculty
Please click here to send any comments via email.
Last Updated 16th January 2014