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Sherry Narang, Todd Shepler, Russel Neuhaus, Roman Shinder; Micro Ear Crocodile Forceps - A Novel Instrument for Endonasal Lacrimal Intubation Retrieval. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1456.
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Nasolacrimal intubation is an effective way to manage epiphora caused by lacrimal system stenosis or obstruction1. To date, conventional techniques are done blindly and require a Crawford hook or a groove director to capture the stent in the nasal cavity2. Our technique of endonasal lacrimal intubation retrieval using micro ear crocodile forceps (Fig) provides direct visualization and is generally simpler to learn, faster to perform, and results in less intraoperative blood loss. These micro forceps are generally used by otolaryngologists to perform middle ear surgery.3
Retrospective review of 64 patients who underwent lacrimal intubation using the following surgical technique. Under general anesthesia, the nasolacrimal system is intubated with either a mono- or bi-canalicular silicone stent after injection of epinephrine containing local anesthesia and oxymetazoline soaked cottonoids to the nasal mucosa. A Freer periosteal elevator retracts the inferior turbinate medially and provides direct visualization of the distal olive tip probe which is grasped and retrieved with the micro ear crocodile forceps through the nare.
31 male and 33 females had a median age of 4 years (range 1-67). Diagnoses requiring lacrimal intubation included: congenital nasolacrimal duct obstruction that failed probing (50 patients), canalicular stenosis (4), functional/partial acquired nasolacrimal duct obstruction (4), bicanalicular laceration (4), and monocanalicular laceration (2). Mean surgical time for endonasal stent retrieval after passage through the inferior meatus was 30 seconds. There were no failures in stent retrieval. Intraoperative blood loss was <5ml in each case.
We propose a novel technique for endonasal lacrimal intubation retrieval using micro ear crocodile forceps. Benefits of this technique over standard retrieval methods include: a faster learning curve, direct visualization and therefore less intraoperative bleeding from the nasal mucosa, and decreased general anesthesia surgical times. Future prospective studies will quantitate the differences in the described technique and more conventional methods.
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