The Caldwell Luc Procedure (CLP) is a surgical technique designed to address complex or long-standing issues within the maxillary sinus, one of the largest air-filled cavities in the face. This sinus is located directly beneath the eye and behind the cheekbone. The operation involves an external approach through the mouth to access the sinus. Although it is an older technique, the CLP remains a relevant option in modern sinus surgery for specific, challenging conditions.
Indications for the Caldwell Luc Procedure
The Caldwell Luc Procedure is reserved for patients whose severe sinus disease has not responded to less invasive treatments, such as Functional Endoscopic Sinus Surgery (FESS) or prolonged medical therapy. It is considered a second-line or salvage procedure when the disease is too extensive or inaccessible for standard endoscopic tools. This approach is necessary for clearing out fungal sinusitis, where thick fungal debris or a fungal ball occupies the entire cavity.
The wide access provided by CLP is required to fully remove large, non-cancerous growths like antrochoanal polyps or extensive mucosal disease. It is also used for removing specific types of fluid-filled sacs or cysts, such as large odontogenic cysts that expand into the sinus space. Finally, CLP addresses foreign bodies, like displaced dental implants or tooth roots, deeply lodged within the sinus cavity that cannot be retrieved endoscopically.
Detailed Steps of the Surgical Technique
The procedure begins with the patient under general anesthesia, though sedation with local anesthesia may be used. The surgeon makes an incision in the gingivobuccal sulcus, the soft tissue fold high on the gum line above the upper canine and premolar teeth. This placement ensures the operation is performed through the mouth, avoiding external facial scars.
After lifting the soft tissues, the surgeon exposes the anterior bony wall of the maxillary sinus, known as the canine fossa. A small, circular “bony window” is created in this thin bone using specialized instruments. This transantral approach provides a direct and wide view into the entire maxillary sinus cavity.
Through this window, the surgeon visualizes and removes all diseased or thickened tissue, polyps, cysts, or fungal material from the sinus lining. Once cleared, a second, permanent opening is created from the sinus into the nasal cavity, usually under the inferior turbinate bone. This inferior meatal antrostomy establishes a new drainage pathway to prevent fluid collection. The bony window is left open to heal, and the initial gum incision is closed with dissolvable sutures.
Post-Operative Care and Expected Recovery
Following the CLP, the patient can expect facial swelling and mild discomfort in the cheek area, manageable with prescribed pain medication and cold compresses. A common side effect is numbness or tingling in the cheek, upper lip, and potentially the upper teeth on the side of the surgery. This occurs because the infraorbital nerve, which provides sensation to this area, passes close to the surgical site and can become irritated.
Patients are advised to avoid forceful nose blowing for one to two weeks to prevent pressure buildup. Dietary modifications are necessary immediately post-operatively, requiring soft foods to protect the suture line until the incision heals. Nasal saline irrigation is encouraged to help keep the nasal passages and the new drainage pathway clean.
Initial healing of the gum incision takes about one to two weeks, after which normal eating and hygiene routines can be resumed. The temporary numbness and swelling subside gradually over several weeks to months as the irritated nerve recovers. Rest and avoiding strenuous activity are recommended during the first week to promote optimal healing.
Potential Complications and Modern Context
While successful in treating severe disease, the Caldwell Luc Procedure carries a risk of specific complications. Due to the proximity of the infraorbital nerve, temporary or, less commonly, permanent numbness or paresthesia (abnormal sensation) in the cheek and upper lip can occur. Other risks include post-operative bleeding, infection at the surgical site, and the potential for sinus disease recurrence.
A rare but significant complication is the formation of an oroantral fistula, an abnormal connection between the mouth and the sinus cavity that occurs if the gum incision fails to heal completely. The procedure’s place in modern rhinology is primarily as a treatment of last resort. Functional Endoscopic Sinus Surgery (FESS) offers a much less invasive option with lower morbidity for most cases of chronic sinusitis.
The CLP is reserved for complex cases where the disease is inaccessible via the nasal cavity or when the extent of the pathology, such as a large tumor or severe fungal infection, demands the wide exposure that only the anterior wall access can provide. This procedure remains a valuable tool in a surgeon’s repertoire.