Caldwell-Luc Approach Research Articles

An Unusual Case of Tooth in the Floor of the Orbit: The Libyan Experience

Maxillary dentigerous cysts although uncommon need to be considered in the differential diagnosis in children with painless facial swelling. We present a case of dentigerous cyst associated with maxillary deciduous canine and maxillary premolars manifesting as a unilateral swelling in canine region of the face. A ten-year-old boy came to oral and maxillofacial surgery unit with a painless left facial swelling. The local dentist had prescribed antibiotics for treatment for the facial swelling, but the swelling did not subside, and the parents brought the child to our unit in Zliten Dental College. After clinical examination and imaging, the diagnosis of dentigerous cyst was made. Caldwell-Luc approach was done, the cyst was enucleated, and primary closure was done. The patient was followed up for a period of two years and there was no evidence of any recurrence.

Sino-orbital Aspergillosis: A Case Report and Brief Review of Literature

ABSTRACT Aspergillosis of head and neck region primarily affects the nose and paranasal sinuses. Any type of paranasal aspergillosis may progress to more aggressive disease illustrating the importance of early recognition of this increasingly encountered disease. The invasive and in particular, the fulminant forms are associated with high mortality. We report a case of invasive aspergillosis of right maxillary sinus and orbit in an immunocompetent individual, along with a critical review and update of the literature. The patient underwent surgery for the debridement of right maxillary sinus through a Caldwell-Luc approach and drainage of orbital abscess as well followed by intravenous therapy of amphotericin B. Recovery with reduction of all the signs and symptoms was seen after 38 days from the appearance of first symptoms. Successful treatment of aspergillosis requires prompt diagnosis and rapid institution of therapy, because delay or nonaggressive therapy can result in the spread of infection with lethal consequences. How to cite this article Neeli AS, Kotrashetti SM, Vallavan P. Sino-orbital Aspergillosis: A Case Report and Brief Review of Literature. World J Dent 2012;3(4):363-366.

Expansile dentigerous cyst invading the entire maxillary sinus: a case report

J Korean Assoc Oral Maxillofac Surg 2012;38:245-8) Reported cases of a large dentigerous cyst involving the whole maxillary sinus are uncommon. A 22-year-old female patient suffering from swelling of the right infraorbital area and cheek with dull pain was referred to our department. Findings on computed tomography (CT) and magnetic resonance imaging (MRI) revealed a huge mass containing a displaced maxillary third molar involving the right maxillary sinus as a whole, with partial erosion of the posterior sinus cortical bone. Under general anesthesia, the mass was enucleated using the Caldwell-Luc approach, and, following histopathological analysis, was diagnosed as a dentigerous cyst. The case was followed for a period of seven years, and no evidence of sinus infection or recurring cyst formation was observed during that time. 1 .�Cysticdevelopentis� usuallyrelatedtouneruptedthirdmolarormaxillarycanine,� andithasthetendencyofdisplacingtherelatedtooth.�A� cystformedaroundthemaxillarythirdmolarmayinvade� themaxillarysinus,�growingunnoticedtosuchextensive� sizeastooccupyaconsiderableportionofthemaxillary� sinus.�Asthecystgrows,�thebonywallsoverlyingthecyst� thinout,�givingrisetoaneggshellsensationuponpalpation� andpossiblytransmittingpressuretothewallsofthesinus;� thuscausingophthalmologicandnasalsymptomstodevelop 2 .� Someuntreateddentigerouscystsmay-inrarecases-grow�

Endoscopic Management of Sinonasal Hemangiopericytoma

Sinonasal hemangiopericytomas (SNHPCs) are rare perivascular tumors with low-grade malignant potential. Traditionally, these tumors have been treated with open approaches such as lateral rhinotomy, Caldwell-Luc, or transfacial approaches. Increased experience with endoscopic management of benign and malignant sinonasal tumors has led to a shift in management of SNHPC. The authors present their experience in the largest series of patients with SNHPC managed endoscopically. Case series at a tertiary care medical center. A retrospective chart review of all patients undergoing endoscopic management of SNHPC at the University of Miami between 1999 and 2008 was conducted. All endoscopic resections were performed with curative intent. Twelve patients with the diagnosis of SNHPC were treated endoscopically. Mean age was 62.5 years (range, 51-83 years). There were 6 men and 6 women. The mean follow-up was 41 months (range, 15-91 months). Seven (58.3%) presented with nasal obstruction, whereas 4 (41.6%) had epistaxis as their initial presenting symptom. Preoperative angiography or embolization was not performed in any case. Mean estimated blood loss was 630 mL (range, 100-1500 mL). Six patients underwent endonasal endoscopic anterior skull base resection; 4 had complete endoscopic resection all with negative margins. None underwent postoperative adjuvant treatment. No recurrence or metastatic disease was observed in this patient population. Endoscopic management of SNHPC is a feasible approach and did not compromise outcomes in this experience. In this series, familiarity with advance endoscopic sinus surgery was necessary to manage these patients. Postoperative adjuvant therapy was not necessary in this cohort.

TWO RARE CASES OF NEOPLASMS OF THE NOSE AND PARANASAL SINUSES

Purpose: To present the diagnostic approach and treatment of two rare neoplasms, hemangiopericytoma and hemangioleiomyoma, treated in the ENT Dept. of Chania General Hospital. description of the cases: A female, 65 years old, with severe nasal congestion, diplopia and exophthalmos and an 82 years old male with unilateral, recurrent, moderate epistaxis were admitted in the ENT Dept. In both cases assessment included full ENT examination, laboratory tests and imaging with CT and MRI scans. For the first patient, due to extension of the lesion in the right maxillary sinus and orbit, excision biopsy with combined Caldwell-Luc and endoscopic approach was decided. Five months after initial intervention she had local recurrence and distance metastasis and underwent adjuvant chemotherapy. She is on follow up without any indication of expansion of the preexisting disease. For the second patient, specimen from the lesion in the left nostril was sent for histology and he denied any further intervention. The patient is on regular follow up without any change from the initial diagnosis. Conclusion: While clinical examination raises the suspicion, diagnosis is confirmed by histology, and extent of disease is evaluated with CT-MRI scans. Imaging should precede biopsy because of high vascularity of these tumors. Appropriate treatment is extensive removal of the lesion. keywords: hemangiopericytoma, hemangioleiomyoma, nose-paranasal sinuses.

Fibrous dysplasia of the maxillary sinus: case report

Introduction and objective: Fibrous dysplasia is a non-neoplastic lesion of unknown origin with one-fourth involving head and neck. The aim of this paper is to report a case of fibrous dysplasia of the maxillary sinus, describing its clinical presentation, radiological features, histopathological appearance and surgical management. Case report: 38-year-old female patient who presented with a history of fullness of the right cheek and intraoral swelling was diagnosed to have fibrous dysplasia of the maxilla with involvement of the maxillary sinus based on the radiological features. The case was managed surgically via a conventional Caldwell-Luc approach. The histopathology of the excised tissue confirmed the diagnosis of fibrous dysplasia. Conclusion:Fibrous dysplasia is a benign non-neoplastic lesion of unknown origin that rarely involves the maxillary sinus. This case report highlights the clinical, radiological and pathological features of fibrous dysplasia and its surgical management. Conventional Caldwell-Luc approach allows more exposure and ensures complete removal of the lesion.

Caldwell-Luc procedure for retrieval of displaced root in the maxillary sinus

The aim of this study was to describe the standard diagnostic procedure and the application of the Caldwell-Luc approach for the retrieval of a displaced root from the maxillary sinus and to share our experience in treating this complication. Twenty-four patients with a fractured root accidentally displaced into the maxillary sinus were referred by general dentists to our department from 2005 to 2008. All were managed by a standardized diagnostic procedure and a Caldwell-Luc approach. We recorded the age of each patient, the gender, the tooth, the size of root fragment, the type of displacement the delay between displacement and retrieval, the length of operating time, and any complications. Over a 4-year period, we treated 24 patients, 14 being male and 10 female. Ages ranged from 14 to 55 years (average 26.4). The commonest tooth involved was the maxillary first molar; the length of the root fragments ranged from 3 to 7 mm. Seventeen of these roots were mobile and 7 fixed (4 being located between the sinus membrane and the bone and 3 immobilized by the sinus membrane. Twenty-three of the operations were completed in 30 minutes, and only 2 patients had a temporary complication of sinusitis. No infraorbital paresthesia occurred. The standardized diagnostic procedure and Caldwell-Luc approach for the retrieval of a displaced root form the maxillary sinus is a safe, simple, and fast method with minimal complications.

A Comparative Study Between Endoscopic Middle Meatal Antrostomy and Caldwell-Luc Surgery in the Treatment of Chronic Maxillary Sinusitis

Functional endoscopic sinus surgery (FESS) has almost completely replaced the radical Caldwell-Luc approach. About 20years after its origin of FESS a comparative study with Caldwell-Luc Surgery (C-L) definitely should be on cards to validate the previous results. To compare the effectiveness of endoscopic middle meatal antrostomy and Caldwell-Luc's surgery in the management of Chronic Maxillary Sinusitis. This is a prospective randomized comparative study based on the analysis of eighty patients who were diagnosed to have chronic, unilateral, maxillary sinusitis and underwent surgery, after a failed trial of conservative management. One year after surgery 44% of the C-L patients and 89% of the FESS patients reported distinct improvement of their symptoms. Both are effective in the management of chronic sinusitis. Endoscopic middle meatal antrostomy is superior to Caldwell-Luc in intraoperative and postoperative parameters.

Adenomatoid Odontogenic Tumor of Maxillary Sinus

ABSTRACT Adenomatoid odontogenic tumor (AOT) is an uncommon tumor of odontogenic origin, constituting only 3% of all odontogenic tumors. AOT is characterized histologically by the formation of duct-like structures with amyloid-like deposits. An 18-year-old male presented with right chek swelling. CT scan revealed well-defined expansile heterogeneous mass with central hypodensity. Patient underwent excision of the mass by Caldwell-luc approach and histopathologically the diagnosis adenomatoid odontogenic tumor was made. Since it is a benign tumor, the treatment should consist of enucleation and curettage.

Root resorption caused by a maxillary sinus mucocele: a case report

A maxillary sinus mucocele is an infrequent but benign lesion that develops from the obstruction of a seromucous glandular duct of the maxillary sinus mucosa. This clinical entity is generally asymptomatic and self-limited. Mucoceles are described as rounded dome-shaped soft tissue masses frequently located on the floor of the maxillary sinus. In this paper, we present a case of a slightly radiopaque well defined shadow arising from the left maxillary sinus floor that produced the root resorption of the upper second left molar. After the surgical removal of the lesion through a Caldwell-Luc approach, histologic study confirmed the initial diagnosis of mucocele. This case report emphasizes the need of clinical and radiologic follow-up to detect any complications associated with these benign lesions, because, in rare occasions, they can show an aggressive growth pattern.

A Case of an Extensive Dentigerous Cyst in the Maxillary Sinus Leading to Epiphora and Nasal Obstruction

BackgroundThe dentigerous cyst is defined as a cyst that originates by the separation of the follicle from around the crown of an unerupted tooth. The clinical examination reveals a missing tooth or teeth and possibly a hard swelling, sometimes resulting in facial asymmetry and possible pathologic fracture. A large maxillary cyst involves the whole sinus and can transmit pressure to the walls of the sinus and, consequently, cause ophthalmologic and nasal symptoms to develop. ObjectivesTo report the case of an extensive dentigerous cyst with swelling of the right cheek, accompanied by unilateral nasal obstruction and epiphora. Case ReportA 21-year-old man presented with swelling of the right cheek, right-sided nasal obstruction, and watering of the right eye. Panoramic radiography revealed a relatively large and well-defined radiolucency enveloping an unerupted maxillary canine tooth. Computed tomography scan showed a cystic lesion measuring 5.2 cm horizontally, 4.3 cm vertically, and 4 cm sagittally, with expansion and erosion of the anterosinus cortical bone. The mass was seen to extend into the right half of the nasal cavity up to the right ethmoid air cells, and was in contact with the base of the skull. The bony margins of the right maxillary antrum were thinned out, the osteomeatal complex was pushed medially-superiorly, and the pterygoid plates were intact. Excision of the dentigerous cyst of the right maxilla was performed using the Caldwell-Luc approach under general anesthesia. ConclusionA dentigerous cyst arising from an unerupted tooth should be considered in the differential diagnosis of nasal obstruction, watering or epiphora of the eye, and fistula of the gingivobuccal sulcus.

Maxillary sinus textiloma: a case report

IntroductionTextilomas have been reported in many locations. We report the first case of textiloma located in the maxillary sinus that mimicked a sinus cyst recurrence on computed tomography images.Case presentationA 60-year-old Caucasian man was referred for persistent infection of the right maxillary sinus. A maxillary sinus benign cyst had been removed three months before. Computed tomography showed a sinus opacity evoking a cyst recurrence. A new operation was planned to remove the cyst by a Caldwell-Luc approach. After excision of very thick fibrous tissue, a compress was discovered in the maxillary sinus. The patient did not present with any sinus infection after the operation.ConclusionThe surgeon should always take into account the possibility of textilomas in a patient with a history of sinus surgery.

Outpatient Endoscopic Removal of Gutta-Percha From the Maxillary Sinus Using a Sublabial Antroscopy: A Rare Entity

Any foreign body in the paranasal sinuses can cause chronic complications. It is therefore important to remove these foreign bodies meticulously. Various approaches are available to accomplish this. This article is a case report of a patient who had gutta-percha as a foreign body in left maxillary sinus, after a gutta-percha point had been used to trace a sinus to confirm that it was an oroantral fistula. Traditional surgical approaches to the maxillary sinus require invasive techniques, such as radical antrostomy and the Caldwell–Luc approach. These may result in further complications and morbidity. The gutta-percha point in this case report was removed endoscopically in an otolaryngology clinic with local anaesthesia using a sublabial antroscopy. There is only one case reported in the dental literature regarding the endoscopically-assisted technique for removal of displaced gutta-percha using the sublabial antroscopy approach (Yura S, Ohga N, Ooi K, Izumiyama Y. Procedure of endoscopic removal of a gutta-percha point in maxillary sinus mucosa by ultrathin arthroscope. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;104:e58–60).

Endoscopic Approach to the Infratemporal Fossa

Classic surgical exposures of the infratemporal fossa region, including the adjacent intracranial space, temporal bone, and sinonasal region, require the extensive exposure associated with the transcranial, transfacial, and transmandibular approaches with their inherent neurological and cosmetic morbidities. In this study, we evaluated the feasibility and exposure afforded by combining 2 endoscopic transmaxillary approaches, endonasal and Caldwell-Luc supplement, to the infratemporal fossa. Endoscopic transmaxillary dissection was performed in 4 formalin-fixed cadaver heads (8 sides). We quantified the extent of exposure achieved within the pterygopalatine and infratemporal fossae after our initial dissection, which was endonasal with a medial antrostomy, and after addition of a Caldwell-Luc incision with an anterior antrostomy. Complementing this anatomic study, we report on a patient in whom this endoscopic transmaxillary approach combining the endonasal and Caldwell-Luc approaches was used for resection of a trigeminal schwannoma in the infratemporal fossa. The combination of these 2 endoscopic transmaxillary approaches enabled visualization of the entire region of the pterygopalatine fossa and anteromedial aspect of the infratemporal fossa. Additional posterolateral exposure of the infratemporal fossa requires significant traumatic traction on the nose. Addition of the Caldwell-Luc transmaxillary approach exposed the remainder of the infratemporal fossa, including the mandibular nerve and branches, middle meningeal artery, and even the distal cervical portion of the internal carotid artery. Endoscopic exposure of the infratemporal fossa is feasible. Using the combination of the endonasal and Caldwell-Luc approaches for direct transmaxillary access significantly extended exposure, allowing safe and effective resection of infratemporal fossa lesions.

The Integrated Surgical Strategy for Removal of Inverted Papilloma Involving the Maxillary Sinus According to the Site of Tumor Origin

Background and Objectives The objective of this study is to determine the appropriate surgical approach for the resection of inverted papilloma (IP) involving the maxillary sinus (MS) according to the site of tumor origin in the MS. Subjects and Method Twenty-six patients who underwent surgery from January 2002 to April 2008 for IP originating from the MS were reviewed retrospectively in regard to the type of integrated surgical approach, site of tumor origin in the MS and the follow-up clinical results. Results Ten cases (38.4%) originated from medial wall of the MS; of these, four EES (endonasal endoscopic surgery), two EMM (endoscopic medial maxillectomy), two EES+CP (canine puncture), and two EES+CLA (Caldwell-Luc's approach) were performed. EES+CP procedure were performed in all three cases (11.5%) of the anterior wall origin. One case (3.8%) that originated from the posterolateral wall was removed by EES+CLA. Four cases (15.3%) originated from the medial-posterolateral wall. Two EES, and one each of EMM and EES+CLA were performed. Three cases (11.5%) originated from the superior-posterolateral wall, of which two cases were removed by EES and the other by EES+CLO (Caldwell-Luc's operation). Two cases of inferior-anterior wall and inferior-posterolateral wall were removed by EES+CLO and EES+CLA, respectively. EES+CLO were performed for three cases of the whole wall origin (11.5%). Two recurrent cases were found in each of EES and EES+CLO. Conclusion IP originated from the MS were successfully managed by EES alone or EES combined with other approaches such as CP, CLA, CLO and EMM. These integrated approaches need to be applied in a gradual manner from less severe to more aggressive cases.

Unusual Foreign Body In The Maxillary Antrum:A Case Report

Foreign bodies in the maxillary sinus are not unusual findings. Many cases have been reported so far with foreign bodies like tooth, dental amalgam, chopstick, matchstick, gutta-percha point, pellets, and even bullet. This paper reports a unique presentation of a patient with regurgitation of fluids in nose and an oro antral fistula; which was later found out to be ribbon gauze as foreign body in the maxillary antrum and was retrieved by Caldwell-luc approach.

Infratemporal hydatid cyst: a case presenting with blindness

We report a very rare case of a hydatid cyst in the infratemporal fossa, causing visual loss over a 10-day period, which disappeared with rapid surgical and medical treatment. A 14-year-old girl presented with right exophthalmos and visual loss. Over a 10-day period, her visual acuity had decreased to detection of hand motion only, due to pressure on the optic nerve caused by a parapharyngeal cyst pressing through a inferior orbital fissure on the right side. A craniotomy had previously been performed for a right frontoparietal hydatid cyst. The patient had been treated intermittently with albendazole. The patient was primarily diagnosed with hydatid cyst, on the basis of her previous medical history and radiological findings, and underwent surgery. Three cysts were carefully removed from the right maxillary sinus, via a standard Caldwell-Luc approach, and the surgical area was irrigated with hypertonic saline. Infratemporal hydatidosis is very rarely reported in the world literature, although hydatid cysts are endemic in many countries, including Iran. We discuss the common presenting features, investigation and treatment options for infratemporal hydatosis. Constant evaluation of adjacent organs is necessary, with treatment as required, due to the propensity of hydatidosis to recur in essential organs. Immediate surgery is recommended, both to prevent the development of disease and to improve the prognosis.

상악동을 침범한 함치성낭종의 임상적 고찰

Background and Objectives: The dentigerous cyst is a developmental odontogenic cyst which originates through alternations of the reduced enamel epithelium in an unerupted tooth. The purpose of this study was to investigate the clinical features of dentigerous cyst, especially those involving the maxillary sinus. Materials and Methods: Retrospective survey of dentigerous cyst was undertaken at the Department of Otorhinolaryngology-Head and Neck Surgery from January 1985 through June 2008. Results: There were 22 dentigerous cysts in this study. They occur over a wide age range with a peak frequency in the second to fourth decades. Every cyst was related to a supernumerary tooth. Facial swelling was the most common presenting symptom. Radiolucent and unilocular lesion was a radiologic characteristic of dentigerous cysts. Nineteen cases were treated by traditional Caldwell-Luc approach. Endoscopic marsupialization was used in three cases. Conclusion: Dentigerous cysts involving the maxillary sinus usually present as facial swelling. Radiologic examinations and clinical features can aid in diagnosis. Complete surgical enucleation can reduce recurrence. Endoscopic marsupialization should be considered carefully as the another option of treatment for dentigerous cyst of the maxillary sinus in selected case. (J Clinical Otolaryngol 2009;20:214–218)

Bacterial biofilms in patients with chronic rhinosinusitis

The possible presence of biofilms was examined in mucosal specimens of 15 patients, undergoing functional endoscopic sinus surgery or a modified Caldwell-Luc approach for chronic rhinosinusitis (CRS). Biofilms were found in 7 of the 15 patients, positive cultures being obtained in most samples, which supports the role of biofilms as an important factor in the pathogenesis of CRS.

Endoscopic Anatomy of the Petrous Segment of the Internal Carotid Artery

Exposure of the petrous (C2) segment of the internal carotid artery (ICA; petrous carotid) is necessary to treat lesions that have spread from the intracranial space or adjacent sinonasal region. Recent advancements in endonasal-endoscopic approaches to the anterior skull base raise the possibility of extending these approaches beyond the sinonasal cavity. In this cadaveric study, we evaluate the feasibility and extent of exposure of the petrous carotid artery via a combined endoscopic endonasal approach. Endoscopic dissection was performed in four formalin-fixed cadaver heads (eight sides). An endoscopic, endonasal, transmaxillary approach was used to identify the cervical and petrous carotid artery. With the endoscopic endonasal, Caldwell-Luc approach, we could visualize the ventral petrous bone after dissecting the contents of the pterygopalatine fossa and infratemporal fossa. Careful dissection allowed exposure of the petrous carotid artery from the upper cervical carotid to the foramen lacerum. In this cadaveric study using an endoscopic endonasal approach for exposure of the petrous carotid artery, combination with the transmaxillary-transpterygopalatine-transinfratemporal approaches permitted exposure of the ventral portion of the artery. The anatomy presented will assist experienced endoscopic skull base surgeons in the removal of lesions involving the ventral skull base.