Lacrimal intubation during dacryocystorhinostomy utilizing the STENTube

Abstract

The traditional use of the Crawford tube for lacrimal intubation during dacryocystorhinostomy (DCR) carries several drawbacks. We describe the use of the STENTube for DCR intubation and detail its advantages. Retrospective, noncomparative, interventional case series; 313 patients with nasolacrimal duct obstruction (NLDO) underwent 339 DCRs (216 external, 123 endonasal) with the STENTube from January 2007 - June 2013 by 5 surgeons (RS, QN, TS, SB, TN) across 3 institutions (SUNY Downstate Medical Center, Texas Oculoplastics Consultants, and Moorfields Eye Hospital). Study outcome measures included patient demographics, surgical complications, and epiphora improvement/resolution. 206 (66%) females and 107 (34%) males had a mean age of 63 years (range 2-94 years). Distribution of diagnoses included: 314 complete idiopathic acquired NLDO, 20 partial idiopathic acquired NLDO, and 5 congenital complete NLDO. 316 (93%) were primary DCRs and 23 (7%) were revisions. Epiphora improved in 312 (92%) cases with 294 (86%) experiencing resolution with patent lacrimal irrigation at a mean last follow-up of 9.4 months. Twenty-eight (8%) patients experienced surgical complications with 16 (5%) experiencing tube prolapse, and 20 (6%) requiring re-operation. The STENTube represents a simple method for lacrimal intubation during external or endonasal DCR at a comparable cost to the Crawford tube. It allows for low prolapse rates without the need for additional endonasal fixation procedures, resulting in a simple and comfortable post-operative extraction without risk of lacrimal trauma. The STENTube is our preferred intubation technique during DCR, and should be considered by oculofacial surgeons performing DCR with intubation.

Scanning electron microscopic features of lacrimal drainage silastic stents: Comparison of various Crawford and large-diameter stents

“…The central segment, which is housed at the medial canthus, is 0.86 mm, still larger than the Crawford. This differential diameter and location facilitate stent security and prevent the complication of stent prolapse [6,7]. The larger diameter segment, which is housed in the canaliculus and the lacrimal sac (in DCR surgeries) and occasionally in the nasolacrimal duct (ELDR), provides a firm approximation with the tissues and mitigates the need for endonasal fixation or additional knots.…”

“…Among the bicanalicular variants, the usage of the Crawford stents is common [3][4][5]. The large-diameter stents like the STENTube R are believed to reduce the prolapse rate, do not need an endonasal fixation and may help with achieving larger post-operative ostia [6,7]. They have been used in DCR surgery and in endoluminal lacrimal duct recanalization (ELDR) along with balloon dacryoplasty.…”

Results of endoscopic endonasal dacryocystorhinostomy: a prospective cohort study

“…The obstruction is bypassed by creating an opening between the medial wall of the lacrimal sac and the lateral wall of the middle meatus of the nasal cavity. The procedure, first explained in early 20 th century, has undergone many modifications since then, and the technique has changed in almost a century from external DCR to non-endoscopic endonasal surgery and then to modern-day endoscopic endonasal DCR 3. Different techniques have been employed to improve surgical success rates of DCR, including intraoperative application of mitomycin-C 4 , intubation of lacrimal passages 5,6 and post-operative topical drugs, including steroids and leukotriene antagonists 7 etc.…”