Modified Caldwell-Luc Approach Research Articles

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

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

Study on Endoscopic Approach for Sinonasal Inverted Papilloma

Objectives: The purpose of this study is to evaluate the endoscopic approach for sinonasal inverted papilloma and outcome of the surgical management. Study design: Retrospective. Place and duration of study: Dhaka Medical college Hospital and Bangladesh ENT Hospital Ltd. of Bangladesh, from January 2006 to December2020. Materials and methods: 189 cases of Inverted papillomas (confirmed by histopathology) presented in last 15 years were managed by Endoscopic Sinus Surgery and the outcome evaluated. Results: The age of the patients ranged from 41 to 80 years. The mean age was 60 years with Male Female ratio 2.04:1.165 patients had unilateral disease and 24 patients had bilateral. Hundred &amp; seventy two patients with inverted papilloma resected by the endoscopic approach,09 patients by nasoendoscopy in combination with modified Caldwell-Luc approach and 8 patients by combined external and nasoendoscopic approach. Follow up revealed recurrence in nine patients. Conclusion: Findings suggest that endoscopic approach is a safe and effective way of treating sinonsal inverted papilloma. Most lesions were entirely resected through endoscopic approach. Importantly surgical strategies need to be thoughtfully chosen based on tumor stage to achieve maximum removal of the lesion and prevent recurrence. J Shaheed Suhrawardy Med Coll 2021; 13(2): 126-129

Caldwell Luc in the era of endoscopic approach for maxillary sinus

Caldwell Luc is a historical procedure for the maxillary sinus, which is more than 100-year-old and is still a useful procedure of choice among surgeons in certain maxillary sinus pathologies. In the era of endoscopic sinus surgeries, the usefulness of Caldwell Luc is often questioned. We report two cases of chronic maxillary sinus disease one with an iatrogenic tooth root in the sinus for 2 years and the other with a mucosal polyp both of which were managed endoscopically earlier but with recurrence of symptoms. Both the cases were managed using a modified Caldwell-Luc approach. The patients were asymptomatic postoperatively with no recurrence.

Maxillary sinus augmentation using biphasic calcium phosphate: dimensional stability results after 3-6 years.

PurposeThis study was designed to observe the resorption pattern of biphasic calcium phosphate (BCP) used for maxillary sinus augmentation over a 3- to 6-year healing period, and to investigate factors affecting the resorption of BCP.MethodsA total of 47 implants placed in 27 sinuses of 22 patients were investigated. All patients had residual bone height less than 5 mm at baseline. The modified Caldwell-Luc approach was used to elevate the maxillary sinus membrane, and the sinus cavity was filled with BCP (70% hydroxyapatite and 30% β-tricalcium phosphate). Implant placement was done simultaneously or in a staged manner. Serial radiographic analysis was performed up to 6 years postoperatively.ResultsDuring the follow-up period, no implant loss was reported. The mean reduced height of the augmented sinus (RHO) was 0.27±1.08 mm at 36 months, and 0.89±1.39 mm at 72 months postoperatively. Large amounts of graft material (P=0.021) and a long healing period (P=0.035) significantly influenced the amount of RHO. In particular, there was a significant relationship between a healing period longer than 40 months and RHO.ConclusionsBCP can achieve proper dimensional stability with minimal reduction of the graft height in a 3- to 6-year healing period after maxillary sinus augmentation. The healing period and the amount of graft material influenced the resorption of BCP.

Endoscopically Assisted Modified Caldwell-Luc Approach to Enucleation of Dentigerous Cyst With Ectopic Tooth From the Maxillary Sinus

Dentigerous cysts in the craniomaxillofacial complex are a benign pathology commonly associated with ectopically placed teeth. Owing to slow and asymptomatic growth, they often attain considerable size before diagnosis that may compromise adjacent anatomical structures. Various techniques for removal of dentigerous cysts from the maxillary sinus have been described. This case report demonstrates a hybrid endoscopically assisted modification of the Caldwell-Luc approach to provide the technical advantages of both techniques.

Anatomic Analysis of the Maxillary Sinus: Preliminary Morphologic Comparison of Animal Models (Pig, Lamb, and Human).

Anatomic Analysis of the Maxillary Sinus: Preliminary Morphologic Comparison of Animal Models (Pig, Lamb, and Human).

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.

Utilization of the Foley catheter in midfacial fracture reduction

Of all the techniques recommended for reducing fractures of the zygomaticomaxillary complex, we have found the one proposed by Jarabak 7 to be superior in our hands. This technique employs the use of an inflated Foley French catheter inserted into the sinus by way of a modified Caldwell-Luc approach. Its advantages over antral gauze packing have been presented. We have employed this technique in twenty-nine cases since January, 1968, with excellent results and no complications.