1. Caldwell Luc surgery (CWS) is over 120 years old and remains an important procedure for ENT surgeons. It involves making a window in the anterior maxillary bone to access and treat diseases of the maxillary sinus. 2. Indications for CWS include chronic maxillary sinusitis, cysts and polyps in the sinus, and benign or malignant tumors. Contraindications are acute infections and performing it in children due to risk of damaging developing teeth. 3. The procedure involves making a U-shaped incision over the canine fossa, removing bone to create a window, excising the sinus lining and lesions, debriding, irrigating, placing a drain, and packing with

1. Caldwell Luc
Surgery
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2. CONTENTS
• Introduction
• Indications
• Contraindications
• Procedure
• Complications
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3. INTRODUCTION
• Caldwell Luc surgery (CWS) is almost 120 years
old now and it still enjoys an important place in ENT
Surgeons practice.
• Radical Antrostomy
• Severely diseased
maxillary sinus.
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4. INDICATIONS
1. Chronic maxillary
sinusitis
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5. Indications - Continued
2. Cystic Condition: ex. Removal of Antral Polyps and Cysts &
Antro-Choanal polyps
3. Neoplastic Condition: Benign and Malignant Lesions.
A. Benign lesion:
· Odontogenic: Ameloblastoma & Adenomatoid Odontogenic
Tumor.
· Non-Odontogenic: Osteoma & Polyp.
B. Malignant Lesion:
· Squamous Cell Ca
· Minor salivary Gland Tumor
· Adenoid Cystic Ca 5

6. Indications - Continued
4. Miscellaneous:
· Removal of any root fragments or, Antrolith
· Zygomatico-maxillary fracture involving the floor of the orbit &
anterior wall of maxillary sinus
· Management of hematoma in the maxillary sinus· Closure of
mouth-sinus communications (oro-antral fistulæ)
·
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7. • Removal of antral mucocoeles
· A route to the ethmoid and sphenoid sinuses.
· Visualisation of the orbital floor for decompression.
· Vidian (nerve of the Pterygoid Canal) neurectomy.
· Access to the pterygo-maxillary fossa
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8. CONTRAINDICATIONS
• It is rarely done in children as damage to
secondary dentition may occur.
• Acute infections
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9. PROCEDURE
1. Anesthesia: GA preferred.
2. Incision of anterior wall of maxilla especially over the canine
fossae, the incision should be semi lunar or, U shaped.
3. Removal of bone & window creation, the breadth of the
window should be not less than the diameter of an index finger.
4. With the help of a periosteal elevator & curator, the whole
lining of the antrum will be excised along with the lesion
(depending upon the type of lesion, fresh bone may need to cut)
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11. 5. Debridement.
6. Irrigation with normal saline.
7. Drainage by naso antral tube, this is called antrostomy
8. Ribbon gauze impregnated with antibiotic solution or, paste is
placed & removed gradually (within -5 days) to facilitate healing.
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13. Post operative protocol
• Postoperative antibiotics + 5 days with analgesic.
• Patient in head end up position and to be instructed not to blow
nose for 2 weeks.
• Pack - removal after 48 h followed by decongestant nasal
drops for 5 days.
• Saline packing — after pack removal.
• Patient was asked to come for regular follow ups at weekly
intervals for 15 days and at 3rd and 6th month.
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14. COMPLICATIONS
• Common Complications:
1- Facial (cheek) swelling
2- numbness of the face (due to effect on infra-
orbital n.). This is numbness of the cheek
and not weakness, which always occurs
temporarily but rarely persists.
3- numbness (temporary / permanent) of the
upper teeth and the associated Gingivae. 14

15. • Less Common Complications:
1- Oro-Antral Communication / Fistula)
2- Post-Operative Nosebleeds (Epistaxis)
3- Overflow of Tears (Epiphora) due to blockage
of the tear duct.
4- Tooth root injury leading to tooth death
(Devitalisation) & Tooth Discoloration
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