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Endoscopic radical antrectomy: a permanent replacement for the Caldwell–Luc operation

Published online by Cambridge University Press:  19 March 2007

H Abd El-Fattah ,
Y A Nour  and
A El-Daly
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Abstract

Introduction:

Chronic inflammation of sinus mucosa is a multifactorial condition which sometimes results in irreversible pathological mucosal changes.

Aims:

To evaluate the efficacy of endoscopic radical antrectomy in treating chronic, hyperplastic, eosinophilic sinusitis, and to compare this procedure with classical endoscopic middle meatal antrostomy.

Materials and methods:

A randomised, controlled trial with parallel design was conducted between July 2000 and December 2004, including 119 patients who fulfilled the clinical, radiological and histopathological criteria for chronic, hyperplastic, eosinophilic sinusitis. Patients were randomly allocated to two treatment groups: classical endoscopic middle meatal antrostomy and endoscopic radical antrectomy. The main outcome measures were recorded in each subgroup at the time of the patient's last clinic visit. In each subgroup, these included subjective improvement and evaluation of the endoscopic appearance of the maxillary sinus.

Results:

Thirty-two per cent of patients in the endoscopic middle meatal antrostomy group were considered surgical failures, compared with 14.5 per cent of the endoscopic radical antrectomy group. This was statistically significant (p = 0.023). Unhealthy maxillary sinuses were significantly more prevalent in the endoscopic middle meatal antrostomy group (p = 0.029).

Conclusions:

In those patients fulfilling the criteria suggestive of chronic, irreversible sinonasal pathology, primary endoscopic radical antrectomy was significantly better than endoscopic middle meatal antrostomy, based on subjective and objective findings.

Keywords

Maxillary SinusEndoscopic Surgical ProceduresParanasal Sinuses

Information

Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 3 , March 2008 , pp. 268 - 276
Copyright
Copyright © JLO (1984) Limited 2007

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References

1 Senior, BA, Kennedy, DW, Tanabodee, J, Kroger, H, Hassab, M, Lanza, D. Long-term results of functional endoscopic sinus surgery. Laryngoscope 1998;108:151–710.1097/00005537-199802000-00001CrossRefGoogle ScholarPubMed
2 Kennedy, DW, Zinreich, SJ, Shaalan, H, Kuhn, F, Naclerio, R, Loch, E. Endoscopic middle meatal antrostomy: theory, technique and patency. Laryngoscope 1987;97(suppl 43):1–910.1288/00005537-198708002-00001Google Scholar
3 Penttilä, MA. Endoscopic findings after functional and radical sinus surgery: a prospective randomized study. Am J Rhinol 1994;8:71–610.2500/105065894781874511Google Scholar
4 Kikawada, T, Nonoda, T, Matsumoto, M, Kikura, M, Kikawada, K. Treatment of intractable diseased tissues in the maxillary sinus after endoscopic sinus surgery with high-pressure water jet and preservation of the periosteum. Arch Otolaryngol Head Neck Surg 2000;126:55–6110.1001/archotol.126.1.55CrossRefGoogle ScholarPubMed
5 Salman, SD, Gonik, L. Another look at functional endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg 1999;7:2–610.1097/00020840-199902000-00002Google Scholar
6 Salman, SD. The abnormal ostiomeatal complex and sinusitis. Am J Rhinol 1992;6:29–3210.2500/105065892781976763Google Scholar
7 Penttilä, M, Rautiainen, M, Pukander, J, Kataja, M. Functional vs. radical maxillary surgery. Failures after functional endoscopic sinus surgery. Acta Otolaryngol Suppl 1997;529:173–610.3109/00016489709124114Google Scholar
8 Forsgren, K, Fukami, M, Penttilä, M, Kumlien, J, Stierna, P. Endoscopic and Caldwell-Luc approaches in chronic maxillary sinusitis: a comparative histopathologic study on preoperative and postoperative mucosal morphology. Ann Otol Rhinol Laryngol 1995;104:350–710.1177/000348949510400503Google Scholar
9 Guo, Y, Majima, Y, Hattori, M, Seki, S, Sakakura, Y. Effects of functional endoscopic sinus surgery on maxillary sinus mucosa. Arch Otolaryngol Head Neck Surg 1997;123:1097–10010.1001/archotol.1997.01900100073010Google Scholar
10 Mackay, IS, Lund, VJ. Imaging and staging. In: Mygind, N, Lildholdt, T, eds. Nasal Polyposis. An Inflammatory Disease and Its Treatment, 1st edn. Copenhagen: Munksgaard, 1997;137–44Google Scholar
11 Kennedy, DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope 1992;102(suppl 57):1–18Google Scholar
12 Kennedy, DW, Zinreich, SJ, Rosenbaum, AE, Johns, ME. Functional endoscopic sinus surgery. Theory and diagnostic evaluation. Arch Otolaryngol 1985;111:576–8210.1001/archotol.1985.00800110054002CrossRefGoogle ScholarPubMed
13 Stammberger, H. Endoscopic endonasal surgery – concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique. Otolaryngol Head Neck Surg 1986;94:147–5610.1177/019459988609400203CrossRefGoogle ScholarPubMed
14 Blitzer, A, Lawson, W. The Caldwell-Luc procedure in 1991. Otolaryngol Head Neck Surg 1991;105:717–2210.1177/019459989110500514CrossRefGoogle ScholarPubMed
15 Fang, SY. Normalization of maxillary sinus mucosa after FESS. A prospective study of chronic sinusitis with nasal polyps. Rhinology 1994;32:137–40Google Scholar
16 Toskala, E, Rautiainen, M. Effects of surgery on the function of maxillary sinus mucosa. Eur Arch Otorhinolaryngol 2005;262:236–4010.1007/s00405-004-0773-5Google Scholar
17 Liu, CM, Yeh, TH, Hsu, MM. Clinical evaluation of maxillary diffuse polypoid sinusitis after functional endoscopic sinus surgery. Am J Rhinol 1994;8:7–1110.2500/105065894781882666Google Scholar
18 Dal, T, Önerci, M, Çağlar, M. Mucociliary function of the maxillary sinuses after restoring ventilation: a radioisotopic study of the maxillary sinus. Eur Arch Otorhinolaryngol 1997;254:205–710.1007/BF00879275Google Scholar
19 Chiu, AG, Kennedy, DW. Disadvantages of minimal techniques for surgical management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2004;12:38–4210.1097/00020840-200402000-00011CrossRefGoogle ScholarPubMed
20 Wynn, R, Har-El, G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis. Laryngoscope 2004;114:811–1310.1097/00005537-200405000-00004CrossRefGoogle ScholarPubMed
21 Bassiouny, A, Abd, El Raouf, M, Atef, A, Naser, S, Talaat, S, Nasr, M et al. A comparative study between ciliary count and the degree of opacity of paranasal sinus CT scans in chronic sinusitis pre- and post-FESS. J Laryngol Otol 2005;119:950–410.1258/002221505775010643Google Scholar
22 Terrier, G. Pathophysiological considerations about the surgical treatment of maxillary sinusitis [in French]. J Fr Otorhinolaryngol Audiophonol Chir Maxillofac 1987;36:114–17Google Scholar
23 Kamel, RH. Endoscopic transnasal surgery in chronic maxillary sinusitis. J Laryngol Otol 1989;103:492–50110.1017/S0022215100156701Google Scholar
24 Wigand, ME, Steiner, W, Jaumann, MP. Endonasal sinus surgery with endoscopical control: from radical operation to rehabilitation of the mucosa. Endoscopy 1978;10:255–6010.1055/s-0028-1098304CrossRefGoogle ScholarPubMed
25 Kountakis, SE, Arango, P, Bradley, D, Wade, ZK, Borish, L. Molecular and cellular staging for the severity of chronic rhinosinusitis. Laryngoscope 2004;114:1895–90510.1097/01.mlg.0000147917.43615.c0Google Scholar
26 Ferguson, BJ. Categorization of eosinophilic chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2004;12:237–4210.1097/01.moo.0000124938.46948.c7CrossRefGoogle ScholarPubMed
27 DeFreitas, J, Lucente, FE. The Caldwell-Luc procedure: institutional review of 670 cases: 1975–1985. Laryngoscope 1988;98:1297–30010.1288/00005537-198812000-00004CrossRefGoogle ScholarPubMed
28 Murray, JP. Complications after treatment of chronic maxillary sinus disease with Caldwell-Luc procedure. Laryngoscope 1983;93:282–410.1288/00005537-198303000-00006Google Scholar
29 Macbeth, R. Caldwell-Luc operation 1952–1966. Arch Otolaryngol 1968;87:630–610.1001/archotol.1968.00760060632016CrossRefGoogle ScholarPubMed
30 Robinson, SR, Baird, R, Le, T, Wormald, PJ. The incidence of complications after canine fossa puncture performed during endoscopic sinus surgery. Am J Rhinol 2005;19:203–610.1177/194589240501900215Google Scholar
31 Ferekidis, E, Tzounakos, P, Kandiloros, D, Kaberos, A, Adamopoulos, G. Modifications of the Caldwell-Luc procedure for the prevention of post-operative sensitivity disorders. J Laryngol Otol 1996;110:228–3110.1017/S0022215100133274Google Scholar
32 Robinson, S, Wormald, PJ. Patterns of innervation of the anterior maxilla: a cadaver study with relevance to canine fossa puncture of the maxillary sinus. Laryngoscope 2005;115:1785–810.1097/01.mlg.0000176544.72657.a6Google Scholar
33 Brownell, DH. Postoperative regeneration of the mucous membrane of the paranasal sinuses: a summary of the published investigations. Arch Otolaryngol 1936;24:582–810.1001/archotol.1936.00640050595003CrossRefGoogle Scholar
34 Hilding, A. Experimental surgery of the nose and sinuses. III. Results following partial and complete removal of the lining mucosa membrane from the frontal sinus of the dog. Arch Otolaryngol 1933;17:760–810.1001/archotol.1933.03570050752004CrossRefGoogle Scholar
35 Goodman, WS. The Caldwell-Luc procedure. Symposium on maxillary sinus. Otolaryngol Clin North Am 1976;9:187–95Google Scholar
36 Damm, M, Quante, G, Jungehuelsing, M, Stennert, E. Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope 2002;112:310–1510.1097/00005537-200202000-00020Google Scholar
37 Cutler, JL, Duncavage, JA, Matheny, K, Cross, JL, Miman, MC, Oh, CK. Results of Caldwell-Luc after failed endoscopic middle meatus antrostomy in patients with chronic sinusitis. Laryngoscope 2003;113:2148–5010.1097/00005537-200312000-00018Google Scholar
38 Wreesmann, VB, Fokkens, WJ, Knegt, PP. Refractory chronic sinusitis: evaluation of symptom improvement after Denker's procedure. Otolaryngol Head Neck Surg 2001;125:495–50010.1067/mhn.2001.119484CrossRefGoogle ScholarPubMed
39 Deal, RT, Kountakis, SE. Significance of nasal polyps in chronic rhinosinusitis: symptoms and surgical outcomes. Laryngoscope 2004;114:1932–510.1097/01.mlg.0000147922.12228.1fGoogle Scholar
40 Smith, TL, Mendolia-Loffredo, S, Loehrl, TA, Sparapani, R, Laud, PW, Nattinger, AB. Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 2005;115:2199–20510.1097/01.mlg.0000182825.82910.80CrossRefGoogle ScholarPubMed
41 Miller, TR, Muntz, HR, Gilbert, ME, Orlandi, RR. Comparison of topical medication delivery systems after sinus surgery. Laryngoscope 2004;114:201–410.1097/00005537-200402000-00004Google Scholar