c. Intranasal Antrostomy (Antral window).
(1) General. This procedure involves making an opening in the lateral wall
of the nose under the inferior turbinate. It is done to relieve headaches, edema,
infection, or swelling of the membranes lining the sinuses.
(2) Operative procedure. After prep and anesthesia, a postnasal plug is
inserted. The inferior turbinate is elevated superiorly by means of a large elevator or
tonsil dissector. An opening is made into the maxillary sinus beneath the inferior
turbinate by means of a gouge, perforator, or antrum cannulae. The opening is
enlarged with cutting forceps and antrum punches. Accessory polyps and degenerate
mucosa are removed with a snare, septum forceps, and suction. The sinus is irrigated
with saline solution by means of a Thornwald irrigator and suction apparatus; the sinus
is packed with petrolatum impregnated iodoform gauze, and the face is cleaned and
d. Radical Antrostomy (Caldwell-Luc Operation).
(1) General. This procedure involves an incision into the canine fossa of the
upper jaw and exposure of the antrum for removal of bony diseased portions of the
antral wall and contents of the sinus, or establishment of drainage by means of a
counteropening into the nose through the inferior meatus.
(a) The upper lip is elevated with a retractor, and a transverse incision
is made in the gingivolabial sulcus just above the teeth; the incision is carried down to
the underlying bone. Periosteum and soft tissue are elevated with dissectors and
(b) The thin bony plate is perforated with a gouge, the antrum is
entered, and its opening is enlarged with nasal rongeurs. The anterior angle of the
sinus may be opened by enlarging the window with Jansen-Middleton septum-cutting
forceps, double-action rongeurs, and Kerrison forceps.
(c) The mucous membrane of the antrum is removed with Coakley or
Myles angled currettes.
(d) Nasoantral drainage may be established by removal of a portion of
the nasoantral wall below the inferior turbinate by means of cutting forceps and rasps.
(e) The antrum is packed with petrolatum gauze.
(f) The labial incision may or may not be sutured. The face of the
patient is cleaned and dried.