This document discusses surgical treatment options for sinusitis. It notes that surgery should only be considered if conservative treatment fails or if signs of sinusitis or intracranial complications emerge. Several surgical procedures are described for treating maxillary sinus disease, including antral lavage, intranasal antrostomy, sinoscopy, and Caldwell-Luc or radical antrostomy operations. The Caldwell-Luc procedure involves a sublabial incision to access and clear out the maxillary sinus. Post-operative care and potential complications are also outlined.

1. SURGICAL
TREATMENT
Dr. Ghulam Saqulain
E.N.T Surgeon, Capital Hospital

2. SURGICAL TREATMENT
“Surgical treatment should be
withheld as far as possible. However, if
conservative treatment does not
succeed in curing the patient in due
course of time, or if external signs of
sinusitis or intracranial complications
threaten, surgical treatment should
become an urgent necessity”.

3. SURGICAL OPTIONS
Surgical
Options
Procedures on
the maxillary sinuses
to treat disease.
Procedures to correct
causative anomalies

4. Procedure to deal with
obstructive pathologies in a hope
to remove cause of disease:
Procedures on the
osteomeatal complex
Procedure on Septum
Procedures on
the turbinates
Functional endoscopic
sinus surgery.
•Septoplasty
•SMR
•Turbinectomy
•SMD
•E/C
•SMR
Procedures on neighboring structures.
•Adenoidectomy
•tonsillectomy
…SURGICAL OPTIONS

5. …SURGICAL OPTIONS
Procedures
to deal with
Sinus disease
Antral Lavage
Intranasal antrostomy
Sinoscopy
Cald- well luc procedure
Denkers
Jensen-Horgan
procedure

6. …SURGICAL OPTIONS
PROCEDURES ON THE MAXILLARY SINUSES
• Antral Lavage (Proof
Puncture):
– It may open the sinus
ostium at least temporarily
and clear any mucopurulent
material (alsoprovide
sample for C/S or H/P)
– Concomittant medical
treatment is necessary or
otherwise the saline left in
the sinus will merely reinfect
– An indwelling polythene
tube fed throughthe cannula
into the sinus allows
relpeated washouts .
Transnasal approach
via. Medial wall of
maxilla.
Sublabial approach via.
anterior wall of maxilla.

7. ….PROCEDURES ON THE MAXILLARY SINUSES
– Principle: The principle of the treatment is to restore
normal mucosa to the sinus linning. This allows the
cilia to waft out through the osteum any residual
infection. If this is not possible ie., when the mucosa
has become irreversibly changed then mucosa
needs to be removed.
• Sinoscopy
• Intranasal antrostomy:
– A large dependent opening in the medial wall of the
antrum is made in the inferior meatus.
– This allows good aeration of the maxillary sinus. It
allows ciliary motion to be restored but adequate
removal of all irreversibly changed antral lining is not
possible.

8. • CALDWELL-LUC or RADICAL ANTROSTOMY OPERATION:
– Sublabial approach to maxillary antrum
– Intranasal inspection and disease clearance
– Antrostomy
• DENKER’S
– Sublabial approach to the anterior angle between bony nose and antral
walls.
– Partial removal of bony pyramidto provide common opening into the
antrum and nasal passage.
• JANSEN-HORGAN
– Caldwell-Luc operation
– Opening and exanteration of posterior and middle ethmoid cells via the
antrum
– Intranasal exanteration of anterior and agger ethmoidal cells.
….PROCEDURES ON THE MAXILLARY SINUSES

9. INDICATIONS:
• Radical cure of chronic sinusitis
• Removal of F.B, usually the root of a molar or premolar
tooth, from the sinus lumen.
• Inspection and biopsy of suspected neoplasm.
• Surgery for dental and other cysts involving antrum
• For adequate removal of antrochoanal polypus.
• To approach to adjacent structures.
CONTRAINDICATIONS:
• Should not beperformed until after the teeth of
secondary dentition have erupted.
….PROCEDURES ON THE MAXILLARY SINUSES
CALDWELL-LUC’S APPROACH

10. …CALDWELL-LUC’S APPROACH
ANAESTHESIA:
•General anaesthesia with oro-tracheal
intubation or naso-tracheal intubation
on unaffected side and cuff inflated.
• A throat pack to avoid spillage of
blood and secretions into the larynx
OPERATION:
•Supine positon with head and neck
flexed on trunk
•Local anaesthetic with 1:200,000
adrenaline solution infiltrated to soft
tissues under upper lip
•Lip retraction and sublabial incision 4
cm above the canine teeth.
•Removal of anterior wall with electric
drill.

11. …CALDWELL-LUC’S APPROACH
•Antrum cleared of disease and mucosa
removed
•Antrostomy opening developed.
•Wound packed with BIPP impregnated
pack brought out via nasal cavity.
•Nasal packing done.
•Dressing done.

12. From
the Doctors Forum Of
E.N.T Department