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Medical Forum / Diseases and Disorders / Sinusitis / February 2005

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chronic sinus disease

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maughold - 25 Feb 2005 20:04 GMT
After FESS and Septoplasty without improving constant sticky drainage
gumming up throat and chest.ENT doctor took tissue samples from Max sinus
for biopsy.Basically it's shot through constant inflammation and
infection.He proposes a Caldwell-Luc to remove all the L/Side Max sinus
lining. Any one with info on this?
Don Brady - 25 Feb 2005 21:54 GMT
>After FESS and Septoplasty without improving constant sticky drainage
>gumming up throat and chest.ENT doctor took tissue samples from Max sinus
>for biopsy.Basically it's shot through constant inflammation and
>infection.He proposes a Caldwell-Luc to remove all the L/Side Max sinus
>lining. Any one with info on this?

From what I've gathered, removing the lining of the sinus is not usually done
any more.

I once had it recommended to me by *one* single surgeon.   I went elsewhere.
None of the others recommended it.

FESS is a very general term.  There are many variations in the way it is done.
It can be doen much more extensively, or less extensively.

I would go to U.Penn or another major center and see what they say.  I doubt
they will recommend the procedure you mention.
Steven L. - 26 Feb 2005 03:04 GMT
>>After FESS and Septoplasty without improving constant sticky drainage
>>gumming up throat and chest.ENT doctor took tissue samples from Max sinus
[quoted text clipped - 4 lines]
> From what I've gathered, removing the lining of the sinus is not usually done
> any more.

True, and there's one more issue.  If all that tissue in his maxillary
is that badly infected, then there's a chance the infection has spread
into the bone (localized osteomyelitis).  If so, then even surgery may
not be the best bet because the infection will remain in the bone and
keep re-infecting the sinus.  Long-term intravenous antibiotics might be
a better alternative.

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Steven D. Litvintchouk
Email:  sdlitvin@earthlinkNOSPAM.net

Remove the NOSPAM before replying to me.

Don Brady - 26 Feb 2005 04:15 GMT
>> From what I've gathered, removing the lining of the sinus is not usually done
>> any more.
[quoted text clipped - 5 lines]
>keep re-infecting the sinus.  Long-term intravenous antibiotics might be
>a better alternative.

Do you tihnk that  long-term intravenous antibiotics has been shown to have a
good chance of success?    I'm worried that it may benefit mainly the providers
of that extremely-high-priced treatment.

Might one not have better odds opening everything wide open with surgery,
including cutting away diseased ethmoid bone?   As you know, the latter
approach is favored by Kennedy et al at U. Penn.
iamthezookeeper - 27 Feb 2005 00:46 GMT
I have had three caudel-luc's done in the past few years. It is the only
way sometimes to get to the maxillary disease. I have had it combined with
FESS and image guided surgery too. This was done by a surgeon that mentored
under the esteemed Dr. Kennedy at UPENN for nine years. The most
uncomfortable part is along the gumline where the stitches run, possibly
some bruising/swelling in the face. I made sure to take my meds and pain
meds as ordered, drank lots of fluids, took vitamins, and got as much rest
as possible for healing. I also took a naturpathic bruise remedy and I
can't remember the name of it, but it really made a difference. Numbness
in the gums has never gone away and I can't whistle now. You can e-mail me
if you like to discuss further. Make sure to reference this conversation.
Trudy.
Don Brady - 28 Feb 2005 00:32 GMT
>I have had three caudel-luc's done in the past few years. It is the only
>way sometimes to get to the maxillary disease. I have had it combined with
[quoted text clipped - 8 lines]
>if you like to discuss further. Make sure to reference this conversation.
>Trudy.

I found this at

http://www.medicdirect.co.uk/operations/default.ihtml?pid=1738&step=4

The Caldwell Luc operation used to be a popular operation for chronic
sinusitis, but with improved understanding of the importance of preserving the
mucous membrane it has fallen from favour. The approach is still used, however,
for a variety of other purposes including the removal of foreign bodies from
the sinus, eg, dental amalgam, access to tooth roots, closure of unwanted holes
between tooth sockets and the sinus following removal of teeth, removal of
benign tumours, for access to structures behind the sinus and for treatment of
fractures of the eye socket. It is not performed in children as the permanent
teeth may be damaged.

this at
http://www.co-otolaryngology.com/pt/re/cooto/abstract.00020840-200302000-00005.h
tm;jsessionid=Cilael1yZaj2HIM0UltK3E3TalNmJhx96ortuRZeQLzjPXbDhQ5c!1142682874!-9
49856032!9001!-1


The Caldwell-Luc operation was first described in the late 19th century as a
technique to remove infection and diseased mucosa from the maxillary sinus via
the canine fossa, while creating intranasal counterdrainage through the
inferior meatus. This operation has been performed countless times over the
past century, but it has come under increased scrutiny within the past 20
years. This criticism is multifactorial. Medical management of allergic and
infectious sinus disease has continued to improve, and endoscopic sinus surgery
techniques have proven to be safe and effective in the vast majority of
patients requiring surgical management. Additionally, several retrospective
studies have shown high complication rates with the operation. Recent studies
have illustrated both the histologic benefit of complete removal of diseased
mucosa, as well as better patient outcomes with minimal morbidity when a safer
operative technique is used. Overall, the Caldwell-Luc procedure is safe and
effective as described, and should remain in the repertoire of surgeons
managing the maxillary sinus.

and this from

http://www.sinusnews.com/Articles2/Sinus-Surgery-Fact-Sheet.html

Caldwell Luc operation: Another option is the Caldwell-Luc operation, which
relieves chronic sinusitis by improving the drainage of the maxillary sinus,
one of the cavities beneath the eye. The maxillary sinus is entered through the
upper jaw above one of the second molar teeth. A "window" is created to connect
the maxillary sinus with the nose, thus improving drainage. The operation is
named after American physician George Caldwell and French laryngologist Henry
Luc and is most often performed when a malignancy is present in the sinus
cavity.
iamthezookeeper - 28 Feb 2005 11:17 GMT
Most likely because of my chronic maxillary disease, the mucoceles in the
maxillary, one wearing away the orbit floor, and the fact I have no
landmarks left, then this seems to be the preferred approach for me. I was
in an accident when I was a young teen that crushed my body, mostly my left
side, and my face. The damage done was internal in that my sinus never
fully developed properly. Hypoplastic they call it. Anyway, in May I had
the entire series done again through image guided and did not have to have
caldwell-luc for the first time. Things still look good in my
ethmoid/frontal due to stents but the rest are opacified once again. I
would get a second opinion as to what was needed Maughold, and ask a load
of questions as to the surgeons experience. Trudy.
iamthezookeeper - 28 Feb 2005 11:22 GMT
Thank you for those articles. They are quite informative and should be
should be used as references when posters want info on surgery. Especially
the last one. Trudy.

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