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Neuroradiology Case of the Week
Case 362
November 2008
Samuel D. Madoff, MD and Per-Lennart Westesson, MD, PhD, DDS
Clinical
Presentation: Patient is a 76-year-old man with a history of nasal obstruction, chronic nasal congestion and a large right sided nasal polyp
Imaging Findings: see below
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Figure 1.
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Figure 2. |
| Figures 1 & 2: Anterior maxillary wall surgical defects are present, as are bilateral antrostomies. |
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| Figure 3: Persistent sinusitis is evident, despite extensive sinonasal surgery. |
Diagnosis: Caldwell-Luc procedure
Discussion: The Caldwell-Luc procedure is named in honor of George Caldwell and Henry Luc, an American doctor and French laryngologist respectively. In the late 19th century, each man independently described this procedure.
The surgery involves an oral approach with an incision above one of the teeth of the upper jaw. A fenestration of the anterior maxillary sinus wall is created. Once entry to the sinus has been obtained, an antrostomy for drainage of the sinus into the nose is fashioned.
This was the primary sinus surgery until it was supplanted in the 1960s by the advent of functional endoscopic sinus surgery (FESS). In the past, a host of indications included treatment of chronic sinusitis, removal of polyps or foreign bodies, facial fracture reduction and accessing the ethmoid or sphenoid sinuses. Today, the Caldwell-Luc procedure is commonly reserved for sinus or odontic tumor excision.
In the case presented, this patient is old enough to have had the Caldwell-Luc procedure during its heyday, particularly for the excision of a concomitant polyp.
References:
- Han JK, Smith TL, Loehrl TA, Fong KJ, Hwang PH. Surgical revision of the post-Caldwell-Luc maxillary sinus. Am J Rhinol. 2005 Sep-Oct;19(5):478-82. [PubMed]
- Barzilai G, Greenberg E, Uri N. Indications for the Caldwell-Luc approach in the endoscopic era. Otolaryngol Head Neck Surg. 2005 Feb;132(2):219-20. [PubMed]
- http://www.entnet.org/HealthInformation/SinusSurgery.cfm
- http://www.nyee.edu/ent_rss_sts_caldluc01.html
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