Surgical Revision of the Post-Caldwell–Luc Maxillary Sinus

Abstract

Background

Endoscopic sinus surgeons are commonly faced with the management of patients with persistent maxillary sinusitis despite previous Caldwell–Luc surgery. Given the potential for altered mucociliary clearance in the post-Caldwell–Luc maxillary sinus, the optimal approach for surgical revision has not been well characterized. The objective of this study was to review our experience in endoscopic versus repeat Caldwell–Luc approaches in patients who have failed Caldwell–Luc surgery for chronic maxillary sinusitis.

Methods

Retrospective chart review was performed on patients who had a history of a Caldwell–Luc procedure and who then underwent a surgical revision for persistent maxillary sinusitis at the Oregon Health and Science University and Medical College of Wisconsin between 1983 and 2002.

Results

Sixty-eight patients were identified, with a total of 156 revision procedures performed on 103 maxillary sinuses. Fifty-three percent of the sinuses underwent endoscopic maxillary antrostomy as the first surgical revision, while 47% underwent a revision Caldwell–Luc procedure. Sixty-seven percent of the sinuses in the revision endoscopic group had clinical resolution with a single surgical revision, and 60% of the sinuses in the revision Caldwell–Luc group had clinical improvement with one surgical revision (p = 0.46). The endoscopic group averaged 1.3 ± 0.5 revision procedures per sinus to achieve clinical resolution, and the revision Caldwell–Luc group averaged 1.7 ± 1.0 revision procedures per sinus (p = 0.3). Mean follow-up was 25 months.

Conclusion

Endoscopic revision of the maxillary sinus yields comparable outcomes to repeat Caldwell–Luc procedure in patients with a history of previous failed Caldwell–Luc surgery. Endoscopic revision surgery is a viable alternative for surgical rehabilitation of the post-Caldwell–Luc maxillary sinus.