Inferior meatal antrostomy: is it necessary after radical sinus surgery through the Caldwell-Luc approach?

In the Caldwell-Luc (CWL) operation, an antrostomy at the inferior meatus is created surgically to promote sinus drainage. This inferior meatal antrostomy (IMA) has been criticized because of the need for an additional time, early loss of the sinusotomy, injury to the nasolacrimal duct, epistaxis from the sphenopalatine artery, and deviation from the normal sinus physiology. This trial was undertaken with specific attention to the question: Is it necessary to perform antrostomy at the inferior meatus after radical sinus surgery through the CWL approach?

Thirty-three patients with a dental origin of sinus disease indicating the CWL operation were entered into this trial. They were treated in blocks of 3, in which IMA was not performed in the first and second patients of each successive block. Only the third patient of each block had IMA performed. Cheek swelling, infection, and failure to relieve the patient's symptoms were the criteria for comparison between patient groups. Cheek swelling was measured by the eye-mouth line and the ear-nose line on the second and fourth day after surgery.

At no time was there a statistically significant difference in cheek swelling between the treated groups (P >.05). No infection or failure of treatment was encountered. However, some patients in both groups had numbness or paresthesias of the cheek, upper lip, upper front gingiva, and teeth. These complaints were transient and lasted for several weeks.

Based on our findings, it does not seem necessary to perform antrostomy at the inferior meatus, provided the patient has a patent osteomeatal complex and no anatomic abnormalities.