I have for the past 8 years suffered with a number of symptoms which had been previously diagnosed as Toothache resulting in 2 extractions and 3 root fillings. I have now consulted an ENT specialist, a CT scan has been taken and I am informed that I have a polyp in my left maxilary sinus. The treatment suggested is a Caldwell-luc procedure. My question is:
(a) What success rate does this procedure have ?
(b) What is the incidence of side effects to this procedure?
(c) Is this the best method by which to proceed (does my location UK have any bearing on the chosen procedure)?
Your comments would be much appreciated.
Reply: --------------------------
The Caldwell-luc operation is a surgical procedure designed to treat chronic sinus disease located in the maxillary sinuses. This operation involves making an incision above the gum of the upper jaw and removing a small amount of bone which forms the front wall of the maxillary sinus. Through the opening in the bone, the surgeon can then remove diseased tissue from within the maxillary sinus. In addition, the surgeon typically enlarges the natural drainage opening from the maxillary sinus into the nasal passage - an older less commonly used approach is to create a new drainage opening along the floor of the sinus - known as a nasoantral window. In the US, Caldwell-luc surgery is much less frequently performed than in years past. More recent studies of chronic sinus disease have revealed that most chronic sinus problems tend to originate in the ethmoid sinuses which are located between the eyes. Studies have also suggested that enhancing the natural drainage pathways in the ethmoid sinuses (through which the maxillary, frontal, and sphenoid sinuses drain) can reverse disease processes located in all of the sinuses. This has led to the development of more modern sinus surgical procedures collectively known as endoscopic sinus surgery. The intent of Caldwell-luc surgery is to remove diseased tissue from the sinus. However, it has been shown that even chronically diseased sinus tissue can return to normal with less aggressive surgical approaches which are essentially designed to improve ventilation and to promote the normal drainage physiology of the sinuses. Caldwell-luc surgery entails greater potential morbidity than endoscopic sinus surgery - recovery time is longer, post-operative pain is typically greater, there is commonly more post-operative facial swelling, etc. Potential risks of Caldwell-luc surgery include scarring which can lead to recurrence of sinus disease, injury to the nerve responsible for sensation to the skin of the cheek, dental injury, facial pain, etc. It is also important to note however, that there are also serious potential complications of endoscopic sinus surgery including injury to the eye, or spinal fluid leakage. However, serious complications are uncommon for either surgical approach. The main concern that most ENT surgeons in the US have regarding Caldwell-luc surgery has to do with a worry that aggressive removal of the tissue lining the maxillary sinus can result in permanent disturbance of the natural function of the sinus lining - known as muco-ciliary function which could possibly be a cause of chronic sinusitis. For these reasons Caldwell-luc surgery is by and large reserved in the US for complicated sinus problems such as tumor removal or recurrent sinus disease associated with irreversible mucosal disease in the maxillary sinus that has failed to respond to prior endoscopic sinus surgery. It is less frequently used as a primary surgical intervention for chronic sinus disease.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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