Jones tube placement #1
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This is Richard Allen at the University of Iowa.
This video demonstrates placement of a Jones tube on the right.
The caruncle is excised with Westcott scissors to provide space for the flange of the Jones tube. An 18 gauge MVR blade is then used to perforate the area of the proposed passage way of the tube. This should be placed in an inferior-posterior direction. This is directed toward the posterior portion of the lacrimal sac fossa where the thin bone resides. The MVR blade can then be used to enlarge the passage way with multiple perforations. A gold dilator is then placed to enlarge the passage way. The intranasal view shows the gold dilator to exit in the area of the middle meatus and appears to be in an appropriate position. A Bowman probe is then placed in the proposed fistula. Intranasal view shows the position of the probe. A hemostat is then used to grasp the probe at the entry to the fistula. This is measured to determine the appropriate length of the Jones tube. The tube is then placed over the Bowman probe and pushed through the fistula. Usually gentle but firm pressure is enough to advance the Jones tube. Do not use instruments to push the tube as this can result in breakage of the tube. I have yet to break a tube with my thumb. Sometimes there is some resistance at the bone. The tube appears in good position externally. Internally, the tube is a little short. A longer tube is then placed which now appears to be resting intranasally in good position. There is good space between it and the middle turbinate and nasal septum.
A double armed 6-0 Vicryl suture is then placed around the neck of the Jones tube and tied. This suture is used to fixate in the tube into position to prevent early post-operative displacement. Each arm of the suture is then placed through the medial portion of the lower eyelid. The sutures are then tied over a cotton bolster. I prefer using a combination antibiotic/steroid drop three times per day for the following week. Ointment should not be used as this will clog the tube. The patient returns in one week for reevaluation and suture removal.