The modified Caldwell-Luc approach for treating odontogenic maxillary sinusitis without need for functional endoscopic sinus surgery (FESS). A retrospective study

Abstract

BackgroundOdontogenic maxillary sinusitis is a common inflammatory condition resulting from the violation of the Schneiderian membrane by conditions arising from the dentoalveolar unit, which includes teeth, their supporting structures, and adjacent tissues. This study aims to evaluate a modified surgical approach for treating this condition. PurposeThe purpose of this study is to measure the frequency of re-treatment of maxillary sinusitis of odontogenic origin following treatment with a modified Caldwell-Luc approach, which involves accessing the maxillary sinus through the canine fossa without creating a counter-opening in the inferior nasal meatus. Study DesignThis retrospective cohort study included 82 cases (83 sinuses) with odontogenic sinusitis treated surgically with the modified Caldwell-Luc technique at the Department of Oral and Maxillofacial Surgery, Poriya Medical Center, between 2014 and 2021. Patients with non-odontogenic sinusitis were excluded. Predictor VariablesAnatomic findings defined as the presence or absence of ostiomeatal complex abnormalities and oroantral communication, as identified through clinical examination and CT imaging. Main Outcome VariablesThe need for retreatment, defined as the requirement for functional endoscopic sinus surgery (FESS) due to persistent signs and symptoms of maxillary sinusitis after the modified Caldwell-Luc procedure, including facial pain/pressure, nasal congestion, purulent nasal discharge, or radiographic evidence of persistent sinus opacification on CT scan, lasting more than 4 weeks despite appropriate medical management. CovariatesCovariates included demographic data (age, sex [male/female as identified at birth]), smoking status, etiologies of odontogenic sinusitis, and surgical conditions. AnalysesDescriptive statistics, Cox proportional hazards regression was used to compute hazard ratios. Kaplan-Meier survival analysis was performed to estimate the probability of remaining FESS-free over time. The level of statistical significance was set at p < 0.05. ResultsThe sample was composed of 82 patients (83 sinuses) with a mean age of 52.3 years (SD 13.5), and 47 (56.6%) were male. Dental implantation and sinus augmentation procedures were the most common etiologies of odontogenic sinusitis (50.6%). The median follow-up time was 6.03 months (IQR: 2.57 - 10.93 months). The incidence rate of FESS requirement was 2.64 per 100 person-months of follow-up. The FESS-free frequency was 89.2% (95% CI: 80.4% - 94.4%). The Kaplan-Meier analysis estimated the probability of remaining FESS-free at 12 months to be 89.1% (95% CI: 79.8% - 94.4%). Patients with OMC abnormalities had a hazard ratio of 2.25 (95% CI: 0.47-10.84, p = 0.31) for requiring FESS, while those with OAC had a hazard ratio of 1.85 (95% CI: 0.46-7.39, p = 0.38). Conclusions and RelevanceThe modified Caldwell-Luc procedure was effective in treating the majority of odontogenic sinusitis cases. FESS may be necessary in a small percentage of cases with persistent symptoms. Further research is needed to identify predictors for FESS requirement. Of note, we recommend that oral and maxillofacial surgery surgeons review sinusitis cases with a FESS surgeon before performing the modified Caldwell-Luc procedure creating the opportunity for simultaneous or closely timed procedures when necessary