The Sinus You Didn't Know You Had: Treating Maxillary Sinus Polyp with Caldwell-Luc

Most people know they have sinuses — at least they know when sinusitis strikes. But few patients know that the maxillary sinus, the largest of the paranasal sinuses, sits immediately above the upper teeth and occupies much of the space inside the cheekbone on each side. It is, in anatomical terms, a remarkable neighbour to the upper jaw — and one that can cause symptoms that are easily attributed to dental problems, when the true source is something entirely different.

This patient presented with chronic symptoms that had not resolved with conventional dental treatment. On investigation, the source was not in the teeth — it was in the sinus above them: a large maxillary sinus polyp.

What Is a Maxillary Sinus Polyp?

A sinus polyp is a benign, inflammatory overgrowth of the sinus mucosal lining. They develop in response to chronic inflammation — most commonly from allergic rhinitis, chronic sinusitis, or recurrent respiratory infections — and can grow to fill a significant portion of the sinus cavity. In the maxillary sinus, they can press against the sinus floor, which sits immediately above the roots of the upper back teeth.

This proximity creates a clinical masquerade: patients may report tooth pain, tooth sensitivity, or a vague heaviness in the cheek — symptoms that send them to the dentist first and the sinus surgeon never, unless someone connects the dots. The OPG and clinical examination in this case revealed the polyp's presence and guided the decision for surgical management.

The Caldwell-Luc Approach: Surgery Through the Cheek

The Caldwell-Luc operation is a classical maxillofacial surgical approach to the maxillary sinus that has stood the test of time for several decades. Rather than approaching the sinus through the nose (the endoscopic route commonly used by ENT surgeons), the Caldwell-Luc approach creates a surgical window through the upper buccal sulcus — the fold of tissue between the upper cheek and the gum.

The procedure involves elevating the mucoperiosteum (the tissue covering the front of the upper jaw bone), creating an opening in the anterior wall of the maxillary sinus (the bony wall you can feel beneath the cheek), and accessing the sinus cavity directly. This gives excellent visual and instrumental access to the full extent of the sinus, allowing complete removal of the polyp under direct vision.

In this patient's case, the polyp — a glistening, dark, polypoid mass — was clearly visible once the sinus was entered. The intraoperative photographs show the Caldwell-Luc window and the polyp being systematically removed. Following removal of the pathology, the buccal sulcus wound was closed.

The Post-Operative Consideration

Maxillary sinus polyps can recur — particularly if the underlying cause (allergy, chronic rhinosinusitis) is not managed. Surgical removal addresses the existing pathology, but patient counselling about allergy management, appropriate follow-up with ENT if indicated, and periodic radiological review are important components of the complete treatment plan.

For Patients and Referring Clinicians

For patients: if you have persistent cheek heaviness, facial pressure, or upper jaw tooth sensitivity that has not been explained by conventional dental evaluation, ask about your sinuses. A simple OPG or CT scan can reveal sinus pathology that has been causing your symptoms all along.

For referring dental practitioners: if an OPG shows a soft tissue shadow or opacity within the maxillary sinus, particularly when it is unilateral and associated with vague dental symptoms that don't have a clear dental cause, a maxillofacial surgical referral is appropriate.

This patient's symptoms resolved after surgical removal of the polyp. What had seemed like a dental problem was, in the end, a sinus problem. And the Caldwell-Luc approach gave us exactly the access we needed to resolve it definitively.

— Dr. Hema | Oral & Maxillofacial Surgeon | Hyderabad