Caldwell-Luc Operation Without Facial Swelling

To read the full-text of this research, you can request a copy directly from the authors.


Postoperative facial swelling remains the most common complication of Caldwell-Luc operation. Over a period of 5 years 128 Caldwell-Luc operations were performed on 76 patients. We have been able to reduce the incidence of postoperative facial swelling to only 5% of all cases, by using a wide sublabial incision, gentle tissue retraction, and avoidance of antibiotic soaked pack after completion of surgery. In none of the cases post operative bleeding was severe enough to warrant antral packing. Only one case required packing 6 h after completion of surgery. This method reduces morbidity of the operation significantly, cuts short the hospital stay and hence a much better patient compliance is achieved.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

Endonasal surgery has emerged as the standard procedure for the majority of nasal and paranasal sinus pathologies. However, some pathological changes beyond the maxillary sinus seem to be out of the instrumental range and are addressed by open approaches. The prelacrimal approach to the maxillary sinus published by Zhou and coworkers has stimulated a rapid development of various procedures in this field. In the current work, the possibilities of the prelacrimal approach are illustrated by means of three clinical cases. The prelacrimal approach enables isolated fractures of the orbital floor to be reconstructed without the risk of lower eyelid complications. Meningo- or encephaloceles in the far lateral aspects of the sphenoid sinus are comparatively well reached via endonasal, transantral, and transpterygoid approaches. Until recently, tumors beyond the maxillary sinus were the domain of open surgery, particularly when they extended laterally of the maxillary sinus. The technique of choice was either a Caldwell-Luc or a midfacial degloving approach. Many of these operations can now be performed via the endonasal prelacrimal approach, with lower morbidity and more rapid postoperative healing. The approach described herein is equal if not superior to the traditional approaches in terms of overview and accessibility.
The complications of the Caldwell-Luc operation were retrospectively studied in 1990. The case records were analysed and updated information from telephone interviews and posted questionnaires were available for most patients. One hundred and eighty-five patients with 216 procedures with a mean postoperative follow-up period of 33.5 months were studied. The commonest indication for the operation was for chronic sinusitis. There were three common complications found: facial swelling (61.9%), pain and/or numbness of the face (46.0%) and pain and/or numbness of the teeth/gums (30.9%). Rare complications are postoperative epistaxis (0.4%), oroantral fistulae (0.4%), epiphora (0.4%) and dental discoloration (0.4%). This paper discusses the pathophysiology of these complications and surgical techniques on how to avoid them. Although the use of the Caldwell-Luc operation has declined in recent years with the development of endoscopic sinus surgery, it still has occasional indications and a set of practical guidelines on how to prevent complications would be useful. The basis for treating chronic sinusitis with functional endoscopic sinus surgery at the expense of the more traditional form of treatment is also discussed.
In the Caldwell-Luc (CWL) operation, an antrostomy at the inferior meatus is created surgically to promote sinus drainage. This inferior meatal antrostomy (IMA) has been criticized because of the need for an additional time, early loss of the sinusotomy, injury to the nasolacrimal duct, epistaxis from the sphenopalatine artery, and deviation from the normal sinus physiology. This trial was undertaken with specific attention to the question: Is it necessary to perform antrostomy at the inferior meatus after radical sinus surgery through the CWL approach? Thirty-three patients with a dental origin of sinus disease indicating the CWL operation were entered into this trial. They were treated in blocks of 3, in which IMA was not performed in the first and second patients of each successive block. Only the third patient of each block had IMA performed. Cheek swelling, infection, and failure to relieve the patient's symptoms were the criteria for comparison between patient groups. Cheek swelling was measured by the eye-mouth line and the ear-nose line on the second and fourth day after surgery. At no time was there a statistically significant difference in cheek swelling between the treated groups (P >.05). No infection or failure of treatment was encountered. However, some patients in both groups had numbness or paresthesias of the cheek, upper lip, upper front gingiva, and teeth. These complaints were transient and lasted for several weeks. Based on our findings, it does not seem necessary to perform antrostomy at the inferior meatus, provided the patient has a patent osteomeatal complex and no anatomic abnormalities.
Toxic shock syndrome is a recently discovered and widely publicized disease found to occur in young menstruating women and thought to be associated with the use of vaginal tampons. To this date, there has been no known report of a similar disease being caused by nasal or sinus packing.
THE HABIT of attaching personal names to anatomical structures, diseases, and operations is difficult to defend scientifically, but it is a convenience. A name sometimes avoids a lengthy descriptive phrase and often it has a mnemonic value. The foramen of Munro may be less descriptive than the interventricular foramen, but it has a rhythm about it and we are stimulated to inquire who Munro was. Similarly we prefer to talk about the Caldwell-Luc operation rather than the radical trans-buccal maxillo-rhinostomy. As an added advantage in this particular case, by using personal names we make it quite clear that we are not referring to the variants of antrostomy described by others such as Denker or Canfield. But things are not always precisely what they seem and a man's name may become attached to something medical because he popularized it rather than because he was the first to describe it. Also, current
Toxic shock syndrome is a recently discovered and widely publicized disease found to occur in young menstruating women and thought to be associated with the use of vaginal tampons. To this date, there has been no known report of a similar disease being caused by nasal or sinus packing. The following is a discussion of the toxic shock syndrome (TSS) and a presentation of two cases that demonstrated a striking similarity to that disease. © The American Laryngological, Rhinological and Otological Society, Inc.
Toxic Shock Syndrome otolaryngologic presentation YARINGTON, I. c.: The CaldweII-Luc operation revisited
  • R Macbeth
  • A Tag
  • F B Mitchell
  • M Haroll
  • W Y Morrison
MACBETH, R.: Caldwell-Luc operation 1952-1966. Arch Otolaryngol. 87: 630-636,1968. TAG, A., MITCHELL, F. B., HAROLL, M., and MORRISON, W. Y.: Toxic Shock Syndrome otolaryngologic presentation. Laryngoscope 92: 1070-1072, 1982. YARINGTON, I. c.: The CaldweII-Luc operation revisited. Ann. 0101. Rhinol. Laryngol. 93: 380-384, 1984. Request reprints to: Dr. B. Baser, Lecturer, Dept. of E. N. T., T. N. Medical College, and B. Y. L. Nair Charitable Hospital, Bombay Central, Bombay 400 008, India
The CaldweII-Luc operation revisited.
  • Yarington I.C.