Classic sinus operations: antral puncture, inferior meatal antrostomy and Caldwell-Luc
- Procedure
Older maxillary sinus operations done before endoscopic surgery; little used today but still asked in exams.
See it in 3D: Maxillary sinus · Inferior nasal conchae · Maxillae · V2 maxillary
What it is
Before endoscopic surgery, the maxillary sinus was treated with three operations. Antral puncture (washout) passes a trocar through the wall of the inferior meatus to wash the sinus. Inferior meatal antrostomy opens a permanent window in that same wall. The Caldwell-Luc operation enters the sinus through the mouth, via the canine fossa, removes the diseased mucosa and leaves an inferior meatal antrostomy. All drain by gravity, against mucociliary transport, which carries mucus to the natural ostium in the middle meatus; this is why endoscopic surgery replaced them. This page is an educational and historical overview.
Indications and contraindications
- Antral puncture: acute maxillary sinusitis not improving with medical treatment, need for culture (immunocompromised, severely ill patient).
- Inferior meatal antrostomy: drainage in patients whose mucosa does not clear; now almost replaced by middle meatal antrostomy.
- Caldwell-Luc: irreversible maxillary mucosal disease, cyst or tooth in the sinus, oroantral fistula, foreign body, some orbital floor fractures.
- Caldwell-Luc was also a route to ligate the maxillary artery in severe posterior epistaxis and to biopsy tumours.
- Caldwell-Luc contraindication: children with unerupted teeth (risk of damaging tooth buds) and an underdeveloped maxillary sinus.
- Puncture contraindication: young children without a developed sinus, suspected tumour or vascular lesion.
How it is done
- Antral puncture: topical anaesthesia, trocar under the inferior turbinate through the lateral wall of the inferior meatus and saline washout.
- The fluid leaves through the natural ostium into the nose; any pus is noted and sent for culture.
- Inferior meatal antrostomy: a wide window is opened in the lateral wall of the inferior meatus, under the inferior turbinate.
- Caldwell-Luc: incision in the upper gingivolabial sulcus, above the roots of the canine and premolars.
- The periosteum is raised, the infraorbital nerve protected and the anterior sinus wall opened in the canine fossa.
- The diseased mucosa, cyst, tooth or foreign body is removed under direct vision.
- An inferior meatal antrostomy is left for drainage and the mouth incision is closed.
Classic maxillary sinus operations compared with endoscopic surgery
| Operation | Route of entry | Drainage principle | Current status |
|---|---|---|---|
| Antral puncture (washout) | Inferior meatus, under the inferior turbinate | Washout through the natural ostium | Rare; diagnosis or culture in selected cases |
| Inferior meatal antrostomy | Lateral wall of the inferior meatus | Gravity | Almost entirely abandoned |
| Caldwell-Luc | Mouth: gingivolabial sulcus and canine fossa | Gravity (inferior antrostomy) | Access for cysts, teeth, foreign bodies and cases the endoscope cannot reach |
| Middle meatal antrostomy (endoscopic) | Nose, middle meatus | Physiological: widens the natural ostium | Current standard |
Complications
- Numbness or pain of the cheek, upper lip and teeth (infraorbital and superior alveolar nerves).
- Oroantral fistula from poor healing of the sublabial incision.
- Facial swelling and cheek haematoma.
- Injury to tooth roots or to tooth buds in children.
- Antral puncture: injury to the orbit or cheek if the trocar strays, air embolism if air is injected, vasovagal reaction.
- Persistent sinusitis because gravity drainage does not correct ostiomeatal complex obstruction.
Next step / Initial management
- For maxillary sinusitis that does not improve: confirm duration and symptoms, check the upper teeth and request sinus CT if referral is planned.
- Initial management: saline nasal irrigation and intranasal corticosteroid (fluticasone); an antibiotic such as amoxicillin only if bacterial criteria are met.
- After a sublabial operation: soft diet, oral hygiene, no forceful nose-blowing and watch for fluid passing from the mouth into the nose.
- Refer on a routine basis to ENT chronic sinusitis that does not respond, persistent one-sided sinusitis or a tooth in the sinus; an oroantral fistula also to dentistry.
- Refer urgently, the same day, if there is eyelid swelling, double vision, reduced vision or severe headache with fever.
Test yourself
Think of the answer, then tap the question to see it.
Why does inferior meatal antrostomy often fail in chronic maxillary sinusitis?
Because mucociliary transport keeps carrying mucus to the natural ostium in the middle meatus, not to the lower window; the ostiomeatal complex obstruction persists.
How is the maxillary sinus entered in the Caldwell-Luc operation?
Through a sublabial incision in the upper gingivolabial sulcus and a window in the anterior sinus wall, in the canine fossa.
After a Caldwell-Luc operation, the patient's cheek and upper lip are numb. Which nerve was injured?
The infraorbital nerve (a branch of the maxillary nerve), and sometimes the superior alveolar nerves, which supply the teeth.
Why is the Caldwell-Luc operation not done in young children?
Because the buds of the permanent teeth fill the maxilla and can be damaged; the sinus is also still small.
Connections
See it in 3D4
The structures of Durgical's 3D anatomy where it is found.
In Pharmacology2
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Endoscopic Sinus Surgery (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2022); Sinusitis (MedlinePlus, U.S. National Library of Medicine, 2026).
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Representative model, for educational purposes only.