The Caldwell-Luc procedure is an external approach to the maxillary sinus through an incision in the superior gingivolabial sulcus with an anterior maxillary sinus antrostomy. This technique was named after George Walter Caldwell of the United States, who described this technique in 1893, and Henri Luc of France, who described a similar technique in 1897. The Caldwell-Luc technique was the most common approach to pathology in the maxillary sinus prior to the development of endoscopic techniques. This technique has been used in the management of chronic sinusitis, for biopsy of tumors, access to the pterygopalatine space for ligation of the internal maxillary artery or vidian neurectomy, access to the floor of the orbit for reduction of fractures, orbital decompression, and access to the ethmoid and sphenoid sinuses and the pituitary fossa. It is still a valuable approach when endoscopic visualization and access is limited, such as in the inferior, lateral, and anterior aspect of the maxillary sinus.

The Caldwell-Luc technique was often complicated by permanent pain and discomfort of the cheek from injury of the infraorbital nerve. Moreover, because the original method of performing the Caldwell-Luc technique included the creation of a large inferior meatal antrostomy, with little appreciation of the function of the natural ostia in the middle meatus, patients with chronic sinusitis were often left with continued sinus dysfunction and symptoms. No wonder in the days when the only approach to maxillary sinus disease was the Caldwell-Luc, otolaryngologists were cautioned “never to operate electively for sinusitis; you will never make them better.”

The Caldwell-Luc technique is now performed in conjunction with nasal endoscopy, and many of these complications can be avoided if one is required to perform a Caldwell-Luc for access. The functional maxillary sinus ostia can be incorporated and enlarged, and with better appreciation of the distribution of the infraorbital nerve, entry into the maxillary sinus via the canine fossa can be performed to avoid disruption of the infraorbital nerve and thus minimize postoperative dysthesias and numbness. Most pathologic conditions of the maxillary sinuses are benign processes such as infections, allergic fungal sinusitis, fungus balls, antrochoanal polyps, and less commonly neoplastic or preneoplastic processes such as squamous cell carcinoma, inverting papilloma, and metastatic tumors. This technique is also used as a direct approach to tumors located in the pterygopalatine fossa posterior to the maxillary sinus.

Table 39.1 lists the lesions from my experience and those reported in the literature that may require the use of the Caldwell-Luc technique. It is indicated for pathology of the lateral, anterior, and inferior maxillary sinuses that is inaccessible endoscopically and is often combined with endoscopic techniques for removal of tumors of the maxillary sinus such as inverting papilloma. It provides access to the infraorbital nerve to address cancers such as squamous cell carcinoma and adenoid cystic carcinoma, which are characterized by perineural invasion and spread along the nerve. The technique assures access to the posterior wall of the maxillary sinus and the pterygopalatine fossa, lateral sphenoid sinus, masticator space, and infratemporal fossa and is used for removal of select cases of juvenile nasopharyngeal angiofibromas, combined with endoscopic techniques. This approach is routinely used in the removal of tumors of dental origin, orthognathic surgery, and repair of comminuted fractures of the floor of the orbit, infraorbital rim, or the maxillary sinus. Edentulous patients undergoing
implants but who have insufficient alveolar bone require augmentation via a “sinus lift,” in which the floor of the maxillary sinus is augmented with a bonelike matrix.