Caldwell-Luc Antrostomy
Caldwell-Luc antrostomy is a surgical procedure that creates a permanent or semi-permanent opening from the canine fossa into the maxillary sinus to allow drainage, clearance of chronic infection, removal of polyps or foreign bodies, and improved ventilation.
Historically common for refractory maxillary sinus disease, it remains a useful approach in selected cases where endoscopic access is limited or when large pathology requires direct access.
Overview And Clinical Background
Direct maxillary sinus access for refractory disease
The Caldwell-Luc approach provides a direct corridor into the maxillary sinus via an intraoral incision in the canine fossa.
It allows surgeons to remove diseased mucosa, fungal debris, tumors or persistent cysts and create a drainage pathway when less invasive endoscopic sinus surgery is unsuitable.
Case selection is critical and modern practice combines endoscopic and open techniques when necessary.
- Typical indications: Chronic maxillary sinusitis refractory to endoscopic surgery, large mucoceles, fungal sinusitis, foreign body removal, or access for maxillary tumor excision.
- Provides wide exposure for complete clearance of disease and septalization or biopsy when needed.
- Procedure aim: Restore sinus drainage, remove disease, and improve mucociliary clearance to prevent recurrence.
Symptoms, Signs And Presentation
Patients usually report persistent facial pain or pressure, chronic nasal discharge, reduced smell, recurrent sinus infections, or facial swelling localized to the cheek/upper teeth.
Symptoms that fail to respond to medical therapy and endoscopic surgery are evaluated for Caldwell-Luc in multidisciplinary review.
- Common features: Chronic purulent nasal discharge, facial pain or pressure over the maxilla, postnasal drip and intermittent fever in infective cases.
- Dental pain or upper tooth discomfort may indicate maxillary sinus involvement or odontogenic origin.
- Red flag: Orbital signs, persistent high-grade fever, or suspicion of neoplasm require urgent imaging and specialist input.
Diagnosis Methods And Investigations
Imaging to plan direct sinus access
High-resolution CT of paranasal sinuses defines disease extent, bony anatomy and dental relationships; MRI helps evaluate soft tissue and suspected fungal or neoplastic disease.
Preoperative dental assessment is crucial when odontogenic infection is suspected.
- CT scan: Essential to delineate sinus anatomy, osteitis, bony erosion, and to plan the antrostomy safely.
- MRI and endoscopy: MRI for soft-tissue characterization; nasal endoscopy assesses intranasal drainage pathways.
- Dental evaluation: periapical radiographs or dental CT to identify odontogenic sources of sinusitis.
Treatment Options And Surgical Techniques
Under general anaesthesia an intraoral incision above the canine tooth exposes the anterior maxillary wall; a bony window is created to enter the sinus, disease cleared, and a natural or artificial drainage pathway established.
Modern practice emphasises mucosal preservation where possible and combining with endoscopic sinus surgery to restore physiologic drainage.
- Open antrostomy: Creation of a bony window in the canine fossa for direct access to remove polyps, mucin, fungal debris or tumors.
- Combined approach: Endoscopic sinus surgery may be performed concurrently to restore ostial patency and improve long-term drainage.
- Adjunctive measures: intraoperative culture, topical antifungals for fungal disease, and careful haemostasis to minimise postoperative complications.
Recovery, Risks And Prognosis
Postoperative course includes facial swelling, numbness in the cheek or upper teeth (usually temporary), and nasal crusting that resolves with saline irrigation.
Complications include infraorbital nerve hypoesthesia, oroantral fistula, bleeding or persistent sinusitis; most resolve with conservative care or minor interventions.
When indicated and performed meticulously, results significantly reduce symptoms and recurrence.
- Early recovery: Swelling and mild facial discomfort for a few days; antibiotics and saline irrigations are typically prescribed.
- Nerve effects: transient cheek/upper tooth numbness from infraorbital nerve irritation often improves over weeks to months.
- Outcome: Durable symptom relief in appropriately selected patients with refractory maxillary disease.
Why Choose Us
CureU Healthcare provides multidisciplinary ENT and dental collaboration, image-guided surgical planning and senior surgeons experienced in combined endoscopic and open sinus procedures.
We prioritise disease clearance, preservation of function and minimising morbidity through tailored approaches.
Conclusion
Caldwell-Luc antrostomy remains a valuable procedure for selected maxillary sinus pathologies where direct access ensures complete disease clearance.
With careful selection and modern techniques, patients achieve lasting symptom relief and improved sinus health.
