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Abstract ID: 24-159
Lester Jones Tube Placement Post-Total Rhinectomy in Squamous Cell Carcinoma: A Case Report
Clarice Giacuzzo
Purpose
This case report demonstrates the complexity of using StopLoss Jones tube (SLJT) in managing lacrimal drainage obstruction in a patient with recurrent nasal squamous cell carcinoma (SCC) who underwent total rhinectomy.
Methods
A 67-year-old patient with a history of nasal squamous cell carcinoma arising from the right nasal vestibule underwent extensive treatment, including radiotherapy and multiple surgeries due to recurrent carcinoma. The last treatment included total rhinectomy and a partial medial maxillectomy, with a second forehead flap reconstruction followed by radiotherapy. Examination revealed bilateral lacrimal drainage obstruction. The patient underwent right conjunctival dacryocystorhinotomy with StopLoss Jones tube (SLJT, FCI Ophthalmics) insertion under general anaesthesia.
Results
There was a dramatic improvement in the right epiphora in the immediate postoperative period, followed by a recurrence. Two weeks post-surgery, examination revealed partially occluded SLJT with discharges and blood clots at the distal end of the tube. Saline syringing restored tube patency temporarily. At the 2-month follow-up, recurring symptoms were attributed to nasal granulation tissue blockage at the distal tube end. Lacrimal cannula and forceful saline solution irrigation cleared the obstruction.
Conclusion
Managing lacrimal drainage obstruction in patients with complex nasal defects poses challenges. Limited anatomical support for Jones tube placement, compounded by recurrent distal tube obstruction due to nasal granulation tissue, demands continuous maintenance of the Jones tube. The pending use of a nasal prosthesis holds the potential for enhancing tube stability, moisture retention, and tube patency.
Additional Authors
Lee Teak Tan – Broomfield Hospital, MSE NHS Foundation trust, Chelmsford, UK
Seyed Ghazi-Nouri – Broomfield Hospital, MSE NHS Foundation trust, Chelmsford, UK