Speakers - 2026

Title: Sinonasal showdown: Functional endoscopic sinus surgery (FESS) or caldwell Luc?

Abstract

Background: Sinonasal ectopic teeth sit at the crossroads of Oral Surgery (OS) and Ear, Nose and Throat (ENT). For decades, Caldwell–Luc has been the go-to approach, giving excellent access but often leaving patients with complications such as infraorbital nerve disturbance or long-term sinus issues. With modern endoscopic techniques, we can now reach these lesions through minimally invasive routes, prompting the question: when is Caldwell–Luc necessary, and when can a coordinated OS-ENT approach achieve the same results with less risk? 

Patient Information: A 37-year-old woman was referred for persistent nasal obstruction and rhinitis over two years. CT imaging showed an unerupted upper third molar along the lateral wall of the right maxillary sinus with a surrounding radiolucency. Imaging alone could not confidently distinguish between a dentigerous cyst and an odontogenic keratocyst (OKC). The case was discussed in a joint OS-ENT meeting to plan the safest approach. 

Management and Outcome: A medial maxillectomy using an endoscopic approach was performed. This allowed careful removal of both tooth and cyst with minimal disruption. Histopathology confirmed an OKC, and the patient was placed on annual MRI surveillance to monitor recurrence.  Recovery was smooth. The patient’s symptoms improved significantly, and there were no postoperative sinus issues. The discordance between imaging impression and final histology highlights the importance of joint evaluation and routine histopathological assessment.  

Key Learning Points: 
Multidisciplinary OS-ENT planning is key for sinonasal ectopic teeth. 
Endoscopic approaches can be a safe, low-morbidity alternative to Caldwell–Luc when anatomy allows. 
Histopathology is essential for guiding follow-up and detecting recurrence. 

The audience take away from presentation:

• A clearer understanding of when endoscopic approaches can safely replace Caldwell–Luc for managing sinonasal ectopic teeth, reducing morbidity without compromising access
• The value of multidisciplinary OS–ENT collaboration in improving diagnostic accuracy, selecting the safest surgical route, and optimising patient outcomes.
• Recognition that imaging alone cannot reliably distinguish OKC from dentigerous cysts, reinforcing the need for routine histopathological analysis.
• Awareness of the importance of long-term surveillance, particularly for lesions such as OKCs that have a known recurrence risk.
• Practical insight into real-world management of a rare presentation, including decision-making, surgical planning, and postoperative care.