Jones tube placement #2
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This is Richard Allen at the University of Iowa.
This video demonstrates a procedural variation of a Jones tube placement.
The caruncle has already been excised. An 18 gauge MVR blade is then placed in an inferior-posterior direction toward the posterior aspect of the lacrimal sac fossa. If resistance is encountered, the blade should be directed a little more posterior. Examination in the nose showed it to be in good position. A straightened crescent blade or 66 Beaver blade is then placed along the surface of the MVR blade and advanced. This allows enlargement of the passage way. A Quickert-Dryden probe is then placed along the surface of the MVR blade. A hemostat grasps the MVR blade at the entry of the fistula. This allows measuring the length of the fistula. A Jones tube of that length can then be selected and placed over the Quickert-Dryden probe. The Quickert-Dryden probe works well as it does not have an obstruction along probe as a Bowman probe does. The Jones tube is then advanced over the probe. Gentle but firm pressure with a digit is used to advance the tube. Do not use instruments for this maneuver as the instruments can break the tube. The probe is withdrawn. Examination of the tube intranasally showed it to be in good position.
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 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. The sutures can be allowed to dissolve or they can be removed at one week. 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.