Fang Christina H, Patel Priya, Huang Grace, Langer Paul D, Eloy Jean Anderson
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Institute of Ophthalmology and Visual Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA.
Am J Otolaryngol. 2015 May-Jun;36(3):330-3. doi: 10.1016/j.amjoto.2014.11.009. Epub 2014 Nov 27.
Conjunctivodacryocystorhinostomy (CDCR) with the insertion of a Jones tube is a surgical procedure used to relieve epiphora caused by upper lacrimal system dysfunction from extensive proximal canalicular obstruction, canalicular stenosis, or canalicular flaccidity. Jones tube obstruction, which is the second most frequent complication of CDCR with tube placement, can result from tube placement against the anterior end of the middle turbinate. In this study, we describe our results in 5 patients who underwent anterosuperior partial middle turbinectomy to prevent obstruction.
A retrospective analysis was performed on 5 patients who underwent selective anterosuperior partial middle turbinectomy to prevent Jones tube obstruction. Three of these patients developed Jones tube obstruction due to contact between a previously placed Jones tube and the anterosuperior aspect of the adjacent middle turbinate. Two other patients had observed contact between the Jones tube and middle turbinate at initial Jones tube placement and underwent anterosuperior partial middle turbinectomy to prevent development of obstruction. Patency of the Jones tube was assessed symptomatically and by nasal endoscopy at the latest follow-up.
All 5 patients displayed a patent Jones tube after a mean follow-up of 29.6 months without complications. Longer-term complications associated with CDCR with Jones tube placement, including continuous epiphora, dacrocystitis, and poor patient satisfaction, were not observed.
Selective anterosuperior partial middle turbinectomy may prevent or relieve Jones tube obstruction, provide increased room along the lateral nasal wall along which to place the Jones tube, and decrease the need for further surgeries arising from tube blockage.
带琼斯管植入的结膜泪囊鼻腔造口术（CDCR）是一种外科手术，用于缓解因广泛的近端泪小管阻塞、泪小管狭窄或泪小管松弛导致的上泪道系统功能障碍引起的溢泪。琼斯管阻塞是带管植入CDCR的第二常见并发症，可能是由于将管子放置在中鼻甲前端所致。在本研究中，我们描述了5例行前上部分中鼻甲切除术以预防阻塞的患者的结果。
对5例行选择性前上部分中鼻甲切除术以预防琼斯管阻塞的患者进行回顾性分析。其中3例患者因先前放置的琼斯管与相邻中鼻甲的前上部分接触而发生琼斯管阻塞。另外2例患者在初次放置琼斯管时观察到琼斯管与中鼻甲接触，并接受了前上部分中鼻甲切除术以预防阻塞的发生。在最近一次随访时，通过症状评估和鼻内镜检查评估琼斯管的通畅情况。
所有5例患者平均随访29.6个月后，琼斯管均通畅，无并发症。未观察到与带琼斯管植入的CDCR相关的长期并发症，包括持续性溢泪、泪囊炎和患者满意度低。
选择性前上部分中鼻甲切除术可预防或缓解琼斯管阻塞，增加沿鼻侧壁放置琼斯管的空间，并减少因管子堵塞而进行进一步手术的必要性。
