The Caldwell Luc Operation is a radical operation in the maxillary sinus performed through the oral vestibule.
Nowadays a problem in the maxillary sinus is usually treated by an operation via the nose and not via the mouth.
In certain situations access via the mouth, or more precisely via the oral vestibule is preferred, for example for tumours, dental foci, inhibition of the A. Maxillaris, pathological processes which are located behind the jaw (known as retromaxillary processes) and when there are complications with access via the nose.
An incision is made in the oral vestibule and the mucosa above the maxillary sinus up to the infraorbital nerve (which provides sensitivity to the upper jaw) are laid open. Ideally the bone shouldn’t be ground away but rather a segment should be cut out with a fine saw. This segment will then be reattached with re-absorbable stitches. By this means we reduce the possibility of postoperative contraction of the maxillary sinus through scarring.
This contraction due to scarring is the reason why this operation is only carried out very rarely and in the case of very pressing indications. When the scar tissue grows back in the maxillary sinus it may impinge on the infraorbital nerve, causing pain for the patient which is very hard to treat.
For this reason nowadays we try as hard as possible not to disturb the mucosa and bone in the maxillary sinus. An alternative is an endoscopic entry. For this first an opening is punched from the mouth into the maxillary sinus with a special instrument. The surgical instruments can then be passed through this opening. Then the endoscope is passed into the maxillary sinus via the nose so that the operator can obtain a good overview of the sinus.
Now altered mucosa is removed by means of the instrument which is inserted in the maxillary sinus via the opening in the mouth. In addition the opening of the sinus to the nose is enlarged in order to allow for better ventilation since this promotes the postoperative healing of the sinus.
The alternatives to the proposed operation depend on the relative indications and should be discussed individually with the doctor treating them.
With an experienced practitioner the risks of such an operation are negligible. Nevertheless complications occasionally occur which make further measures necessary. With every necessary further measure there is a further possibility of complications which could even progress to become life-threatening. Here only the particular complications of a surgical intervention within the maxillary sinus are mentioned and these are:
- Pain due to scarring
- Inflammation of the bone (Osteomyelitis)
- Injury to surrounding structures such as eyes, nose, brain, nerves, blood vessels or roots of teeth with the related consequences
- Infection of the wound
- Disturbances to sensation in the cheeks, lips and teeth
Fortunately due to the positive developments in medicine in the last decades such complications have become very rare.
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