Bechara Y. Ghorayeb, MD, PA
Otolaryngology-Head & Neck Surgery                                                              Phone: 713 464 2614
1140 Business Center Drive, Suite 560
Houston, TX 77043                                                                         www.ghorayeb.com
Caldwell-Luc Operation
Informed Consent
This procedure is used to open the maxillary sinus and remove its diseased lining.  Occasionally, it is used to biopsy a tumor or gain access to the floor of the orbit, the ethmoid sinus or the internal maxillary artery.  A small cut is made between the upper lip and gum and a tiny piece of bone is removed from the anterior wall of the maxillary sinus.  The natural opening of the sinus into the nasal cavity is often enlarged at the same time to improve drainage of normal secretions and reduce the chance of recurrent disease.  Occasionally, a new opening (naso-antral window) is also created between the nose and maxillary sinus.

Since this operation was first performed at the end of the 19th century, a vast amount of knowledge has developed not only about its proven value as a method to treat maxillary sinus disease but also about potential risks, which fortunately are infrequent.

Facial swelling is the most common side effect of this operation.  It usually lasts a few days and resolves spontaneously. It is occasionally associated with some bruising, especially in the elderly. The swelling and bruises tend to migrate downwards toward the neck.  Numbness and tingling (not weakness) of the cheek and upper lip may occur. These usually subside in a few weeks, but could be permanent. Very rarely, facial pain may occur and last several weeks before improving. There is a small risk of discoloration or numbness of the nearby upper teeth. Finally, in extremely rare instances, a communication between the mouth and the sinus (oro-antral fistula) may occur if the sutures break down.  It usually closes by itself, but sometimes, it may require another procedure to close the defect.

I/We have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of non-treatment, the procedures to be used, and the risks and hazards involved, and I/we have sufficient information to give this informed consent. I/We certify this form has been fully explained to me/us, and I/we understand its contents. I/We understand every effort will be made to provide a positive outcome, but there are no guarantees.


Patient / Legal Guardian :__________________________________________________

Witness:_______________________________________________________________

Date:__________________________________Time:___________________________


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