3.8\ Caldwell-Luc Procedure

3.8.1\ Discussion

The Caldwell-Luc procedure was described by Caldwell in 1893, Spicer in 1894, and Luc in 1897 for the treatment of maxillary sinusitis. The technique originally consisted of creating a defect in the inferior aspect of the anterior maxillary wall via a canine fossa approach and removing diseased mucosa from the maxillary sinus, combined with inferior or middle meatus antrostomy, in order to facilitate gravitational intranasal counterdrainage and antral lavage (Fig. 3.13).

Historically, the Caldwell-Luc procedure was the primary sinus surgery until it was largely supplanted by functional endoscopic sinus surgery. The Caldwell-Luc procedure has fallen out of favor since it interrupts the ciliary clearance mechanism of the maxillary sinus mucosa. As a result, the procedure often exacerbates the conditions that it is intended to treat. Indeed, on postoperative imaging, inflammatory sinus disease, sinus collapse, and sinus wall sclerosis (osteitis) are found in over 80%, over 90%, and up to 100% of cases, respectively (Fig. 3.14). Currently, modification of the Caldwell-Luc procedure is mainly reserved as an approach for resection of selected maxillary sinus tumors and antrochoanal polyps.

Fig. 3.13  Caldwell-Luc surgery. Coronal CT image shows a defect in the left anterior maxillary sinus wall (arrowhead) and nasoantral wall (arrow)

Fig. 3.14  Chronic recurrent sinusitis after bilateral Caldwell-Luc surgery. Axial CT shows the bilateral postoperative changes with mucosal thickening and hyperostosis of the remaining maxillary sinus walls