Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London
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Focal septoplasty and partial middle turbinectomy as part of a Lester Jones tube insertion procedure
Author: Zoran Zikic
ePoster Number: 274
To present a case in which, in order to properly perform a conjunctival dacryocystorhinostomy (CDCR) with Lester Jones tube (LJT) insertion, supplemental endonasal procedures were necessary.
A 59 year old male patient, suffering from epiphora due to canalicular blockage on the right side, underwent CDCR with LJT insertion, in general anesthesia. Preoperative nasal endoscopy showed a narrow nasal passage, so a focal septoplasty was part of the surgical plan. After nasal decongestion, the septal mucosa was incised anterior to the hump which narrowed the access to the site of the endonasal endoscopic dacryocystorhinostomy (endo DCR). The septal cartilage of the hump was resected and the mucosa repositioned. After that an endo DCR was performed. Following excision of the lacrimal caruncule, the sharp end of the guide wire was directed from the medial angle to the site of the endonasal ostium in order to create a passage for the dilator and tube gauge. Despite angle adjustement it was not possible to do this without impingement on the middle turbinate. To resolve this issue the anterior part of the middle turbinate was resected with Gruenwald cutting forceps. This enabled the insertion of a “stop-loss” LJT (FCI, France), of adequate length. The proximal part of the LJT was secured with a temporary suture and the endonasal surgical sites covered with absorbable hemostatic sponge pieces, soaked with triamcinolone suspension.
Postoperatively, the patient was free from epiphora and nasal endoscopy showed a well positioned nad mobile LJT.
In order to secure long lasting results of lacrimal drainage surgery with LJT tube insertion, the tube needs to be properly positioned and freely mobile with blinks and eye movements, otherwise subsequent complications may occur. Good visualization and access of the rigid endoscope and instrumentation to the site of the endo DCR are important for the surgical procedure itself, as well as for postoperative tube monitoring and maintenance. The lacrimal surgeon should be aware of the possible need for the above described supplemental procedures.
|First name||Last name||Base Hospital / Institution|
|Dragisa||Jovic||Medicolaser Eye Clinic, Banja Luka, Republic of Srpska, Bosnia and Hercegovina|
Abstract ID: 21-178