31032 Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with removal of antrochoanal polyps

Name of the Procedure:

Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with removal of antrochoanal polyps

Summary

A radical maxillary sinusotomy, specifically the Caldwell-Luc procedure, involves creating an opening in the maxillary sinus to remove antrochoanal polyps. This procedure is often performed when less invasive treatments have not been successful in addressing chronic sinus infections and polyps.

Purpose

The primary aim is to treat chronic sinus infections and remove polyps that block the nasal passages, improving breathing and reducing sinus-related symptoms. This procedure also facilitates drainage and prevents recurrent sinus infections.

Indications

• Chronic sinusitis unresponsive to medication
• Nasal obstruction due to antrochoanal polyps
• Recurrent sinus infections
• Symptomatic maxillary sinus disease
• Failure of less invasive treatments

Preparation

• Fasting for at least 6-8 hours before surgery if general anesthesia is used.
• Adjustments to medications as advised by the physician, such as blood thinners.
• Pre-surgical diagnostic imaging like CT scans to assess the extent of the disease.

Procedure Description

1. The patient is typically placed under general anesthesia.
2. An incision is made inside the upper lip to access the maxillary sinus.
3. A small window is created in the anterior wall of the sinus.
4. The surgeon removes any polyps, infected tissue, or debris.
5. The sinus is irrigated, and any further necessary repairs are made.
6. The incision is closed with sutures.

Tools include surgical drills, endoscopes, and irrigation systems. The procedure is often done with endoscopic guidance.

Duration

The procedure typically takes 1 to 2 hours, depending on the extent of the disease and complexity.

Setting

Performed in a hospital or surgical center, usually in an operating room.

Personnel

• ENT surgeon (otolaryngologist)
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Bleeding
• Injury to adjacent structures (e.g., eye, teeth)
• Scar tissue formation
• Altered sensation in the teeth or face
• Recurrence of polyps
• Rarely, cerebrospinal fluid leak

Benefits

• Relief from chronic sinusitis symptoms
• Improved nasal breathing
• Reduced frequency of sinus infections
• Long-term resolution of nasal obstruction
• Enhanced quality of life with fewer sinus-related health issues

Recovery

• Post-operative nasal packing may be used and removed after a few days.
• Prescription of pain relief and possibly antibiotics for infection prevention.
• Nasal irrigation and decongestants to aid healing.
• Return to normal activities in about 1-2 weeks, avoiding strenuous activities for up to 4 weeks.
• Follow-up appointments to ensure proper healing and function.

Alternatives

• Medical management with antibiotics, nasal steroids, or decongestants
• Endoscopic sinus surgery (less invasive)
• Balloon sinuplasty (for less severe cases)
• Pros of alternatives include lower risk and shorter recovery, cons are less effective in severe or chronic cases.

Patient Experience

Patients can expect some discomfort and swelling in the face and teeth. Pain is generally managed with prescribed medications. Breathing might be difficult initially due to nasal packing or swelling, but improvement is typically noticed shortly after packing is removed.