AbstPaCt nas^een rePorted in 16 to 40 percent of all cases.1 The main causes of involvement are fractures of the maxilla or the zygomatic (malar) bones, perforation into the sinus during extractions of teeth, radicular (periapical) lesions that extend into the sinus, extrusion of root canal filling material into the sinus, and foreign bodies or roots forced into the sinus during extractions.The classic approach to the maxillary sinus is as follows: A horizontal incision is made in the gingivobuccal sulcus wall above the root of the teeth in the nonattached gingivae.The incision runs from the canine area to the area of the second molar and is made through the mucosa and the periosteum to the bone. The periosteum is elevated, exposing the entire lateral wall of the maxillary sinus up to the infraorbital foramen. The anterior wall of the sinus is fenestrated with an osteotome, enlarging the opening so that the contents of the sinus can be observed A major problem with the classic Caldwell-Luc operation is the hammering on the maxilla when the antrum is opened. There is also the problem of visibility because of the bleeding incurred in such an operation.The classic surgical approach to the maxillary sinus originally described by Caldwell and Luc is still widely used. An incision is made with a scalpel in the upper part of the buccal vestibulum, and the anterior wall of the sinus is fenestrated with an osteotome. This procedure often is performed under general anesthesia. Postoperative swelling, edema, and pain are usually seen. The C02 laser is an alternative surgical technique that cuts the mucosa and the periosteum, opens the anterior wall of the sinus, and vaporizes the contents of the sinus. The procedure can be used with local anesthesia. Aside from the hemostasis, postoperative swelling, pain, and discomfort are negligible.
