J Oral Maxillofac Surg 62:559-562, 2004 Inferior Meatal Antrostomy: Is It Necessary After Radical Sinus Surgery Through the Caldwell-Luc Approach? Fouad A. Al-Belasy, BDS, MSc, PhD* Purpose: 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 under- taken with specific attention to the question: Is it necessary to perform antrostomy at the inferior meatus after radical sinus surgery through the CWL approach? Materials and Methods: 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. Results: 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. Conclusion: 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. © 2004 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 62:559-562, 2004 Since its introduction, the use of the Caldwell-Luc (CWL) operation has been universally accepted in cases of irreversible chronic maxillary sinusitis, antral tumors, and trauma and as a technique for gaining access to the pterygomaxillary fossa and perisinus. 1 The CWL operation is also required for removal of mucoceles, pyoceles, intrasinus odontogenic cysts and tumors, and foreign bodies, as well as for closure of an oroantral fistula. In the CWL operation, an opening at the inferior meatus is created surgically. The purpose of perform- ing this inferior meatal antrostomy (IMA) is to pro- mote sinus drainage. Being in a more dependent po- sition, the IMA theoretically allows passive drainage of reaccumulated material. 1 Its more accessible loca- tion also facilitates suction toilet postoperatively. 2 However, surgical creation of the IMA requires addi- tional time and sometimes injures the nasolacrimal duct. 3 Moreover, the IMA was reported to be closed within 3 months after the operation in 82% of 367 cases. 4 This early loss suggests low value for the sinusotomy. 3 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? Materials and Methods A total of 33 male and female patients aged 21 to 39 years were included in the trial. At examination, they were diagnosed as having a dental origin of sinus disease that indicated radical sinus surgery via the CWL approach (Table 1). They all were required to have patent osteomeatal complex and to not have anatomic abnormalities such as septal deviations, con- cha bullosa, and nasal polyps. Patients were excluded if they had a history of any immunocompromise con- *Associate Professor, Oral Surgery Department, Faculty of Den- tistry, Mansoura University, Mansoura, Egypt. Address correspondence and reprint requests to Dr Al-Belasy: Oral Surgery Department, Faculty of Dentistry, Mansoura Univer- sity, Mansoura, Egypt; e-mail: albelasy@netscape.net © 2004 American Association of Oral and Maxillofacial Surgeons 0278-2391/04/6205-0006$30.00/0 doi:10.1016/j.joms.2003.07.009 559