Title: Nasolabial Mass (Ameloblastoma) Excision by Caldwell Luc Approach

Biography:

Shanu Kher is a second-year otorhinolaryngology resident at Surat Municipal Institute and Medical Education and Research hospital in the city of Surat, who has also contributed to research done by Manit Mandal "Fat myringoplasty for small central perforation of the tympanic membrane: A prospective study", along with her duties in the hospital and training.

Abstract

Statement of the problem:
Caldwell Luc operation, also known as Caldwell Luc antrostomy, is an operation to remove irreversibly damaged mucosa of the maxillary sinus. The approach is mainly through the anterior maxillary bone. It was introduced by George Caldwell and Henry Luc. It can be a useful approach for recurring nasolabial mass, though there might be a risk of cosmetic appearance being compromised as it happened with this patient.
Methodology and theoretical orientation:
The maxillary sinus in the Caldwell Luc operation is entered from two separate openings, one in the canine fossa to gain access to the antrum and the other in the nasoantral wall for drainage. In this particular patient, the access was gained by the same method only. A mass of approx. size 2x3 cm2 in size was excised from the maxillary antrum. The patient was followed up for 3 weeks, with no recurrence. The only complaints the patient presented with were pain at the local site and elevation of the upper lip near the operated site without any significant disability reported.
Findings:
A 27-year female patient presented to ENT OPD with complaints of painless swelling over the left side of the cheek which was gradually increasing in size and intermittently painful. The patient was operated case of a cyst in 2018 and 2019 by the marsupialization method by the dental surgeon (no records available) On examination, single swelling was noted on the left side of the nasolabial fold with an elevation of the left side of the upper lip of approx. size 2x2 cm in size, it was cystic, non-mobile, non-tender, non-pulsatile with overlying skin free. Fullness was present on the left upper gingivolabial sulcus opposite to the left upper canines which were fluctuant on palpation, non-discharging, non-tender with a scar mark on the mucosal aspect of the upper lip due to previous surgery. CT Paranasal sinuses were suggestive of 20x24x30mm size expansile lytic homogeneously enhancing soft tissue density lesion with a narrow zone of transition seen in the maxilla on the left side in the region of 2nd, 3rd, 4th and 5th teeth. Anteriorly, extending up to the left nasolabial region and the left premaxillary region. Medially, abutting membranous nasal septum. Posteriorly, abutting the anterior wall of the left maxillary sinus. Inferiorly, into the floor of the left maxillary sinus, associated with thinning.
Operation:
Left nasolabial mass excision by Caldwell Luc approach under General anesthesia. Histopathology report was suggestive of Ameloblastoma of solid variant.
Conclusion and significance:
On 1 year of follow-up, showed no signs of recurrences. There was pain localized to the operated site for nearly 6 weeks of follow-up apart from having complaints of an external appearance of the upper lip. Ameloblastoma is a rare histopathological finding, locally invasive, and infiltrates through medullary spaces and erodes the cortical bone; this patient happened to be histopathologically diagnosed with it.