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The Caldwell-Luc procedure, or radical antrum operation, is a type of surgery where a hole is made in one of the maxillary sinuses in the skull. A sinus is an air chamber inside the bones of the skull, and the maxillary sinuses are located in the area of the cheeks, below the eye sockets. The Caldwell-Luc procedure may be carried out using either a local or a general anesthetic and the operation lasts for up to an hour. Patients are usually able to return home the following day. Nose bleeds, swelling of the face and numb cheeks may be experienced for several days after surgery.
Originally, the Caldwell-Luc procedure was carried out to treat chronic maxillary sinusitis, where a hole was created to drain the contents of the infected sinus. Since the introduction of keyhole surgery to treat sinusitis, the Caldwell-Luc procedure has been more frequently used for other purposes. These include the removal of tumors and foreign bodies from a sinus, the repair of broken eye sockets, and the treatment of certain dental conditions, as the upper teeth grow down from the floor of the maxillary sinuses. Occasionally, the Caldwell-Luc procedure is used in preference to keyhole surgery, for example in cases of sinusitis caused by severe fungal infections, where extensive removal and drainage is required.
During the Caldwell-Luc procedure, the upper lip is raised and an incision is made at the junction of the upper gum and the inside of the cheek. After cutting through to the bone, a surgical hammer and a bone-cutting instrument resembling a chisel are used to create a hole in the front of the maxillary sinus. The opening may be enlarged to varying degrees depending on the purpose of the operation.
Care is taken to avoid a nerve known as the infraorbital nerve, which emerges from the skull just below the eye socket and travels to the skin overlying the cheek. Damage to the nerve would cause the cheek to lose sensation. In the case of infections, sometimes an extra hole is made connecting the maxillary sinus to the nasal passages, to allow drainage into the nose.
After the Caldwell-Luc procedure has been carried out, the maxillary sinus may be washed out and closed with dissolvable stitches. If dentures are normally worn, they should be replaced the day following the operation, before scar tissue forms. For around two weeks following surgery it is important to avoid blowing the nose, and sometimes nasal packing is required for a while if bleeding is excessive.