Name of the Procedure:

Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of antrochoanal polyps

Summary

The Caldwell-Luc procedure is a type of sinus surgery designed to clear out the maxillary sinus. It involves creating an opening in the upper jaw to access and remove diseased or infected tissue within the sinus cavity. This particular procedure does not involve the removal of antrochoanal polyps.

Purpose

The primary purpose of the Caldwell-Luc procedure is to treat chronic or recurrent maxillary sinus infections that do not respond to conservative treatments. The goal is to clear the infected tissue and improve sinus drainage, thereby relieving symptoms such as pain, pressure, and nasal congestion.

Indications

• Chronic maxillary sinusitis that is unresponsive to medication
• Recurrent maxillary sinus infections
• Blocked sinus drainage pathways causing frequent sinus headaches
• Persistent facial pain or pressure due to sinus issues

Preparation

• Fasting for 6-8 hours before the procedure if general anesthesia is used
• Discontinuation of certain medications as advised by the healthcare provider
• Preoperative imaging, such as a CT scan, to map the sinus anatomy
• A thorough medical and anesthesia evaluation prior to surgery

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made inside the mouth, above the upper teeth.
3. The surgeon creates an opening in the bony wall of the maxillary sinus.
4. The sinus cavity is accessed and any infected or diseased tissue is removed.
5. The sinus is irrigated, and the surgeon ensures proper drainage.
6. The incision inside the mouth is closed with sutures.

Tools and technology used may include scalpels, endoscopes, and suction devices.

Duration

The procedure typically takes about 1 to 2 hours to complete.

Setting

The Caldwell-Luc procedure is generally performed in a hospital or surgical center.

Personnel

• Otolaryngologist (ENT surgeon)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Bleeding
• Infection
• Swelling or bruising of the face
• Numbness of the upper lip or teeth
• Sinus complications such as persistent drainage issues
• Rare risk of damage to surrounding structures like the eye socket

Benefits

• Relief from chronic sinus infections and associated symptoms
• Improved sinus drainage
• Reduction in the frequency and severity of sinus-related headaches
• Enhanced quality of life

Recovery

• Patients may need to stay in the hospital for a day or two.
• Pain and discomfort will be managed with prescribed medications.
• Nasal and oral care instructions will be provided, including saline rinses.
• Activity restrictions and guidelines to avoid strain on the surgical site.
• Follow-up appointments for monitoring healing and removing sutures.

Alternatives

• Medications such as antibiotics and corticosteroids
• Balloon sinuplasty (less invasive)
• Functional endoscopic sinus surgery (FESS)
• Pros: Less invasive options have shorter recovery times and fewer risks.
• Cons: Non-surgical options may not be effective for patients with severe or persistent conditions.

Patient Experience

During the procedure, patients will be under general anesthesia and will not feel pain. Post-procedure, mild to moderate pain, swelling, and nasal congestion can be expected. Pain is usually well-controlled with medications, and patients are given detailed aftercare instructions to ensure a smooth recovery.