We read Mombaerts and Colla’s article with interest, and have a few comments concerning their technique.
First, we believe that the use of an endoscope or direct intranasal visualization to assist in the insertion of the tube is critical to avoid contact of the tube with the middle turbinate or nasal septum. This is also very important to decide the appropriate length of the tube. If the surgical tract is not seen, the tube may even be inadvertently placed through the middle turbinate.
We described a technique of insertion of the standard Jones tube through a closed approach but under endoscopic or nasal view.2 In our series, only 3 of 55 patients (5.5%) required a secondary procedure to reposition the migrated tube, versus a reintervention rate to correct tube migration of 23% described by the authors. Also, all our patients (100%) experienced a complete relief of epiphora, versus only 87% reported by the authors.
We believe that the use of a 14-gauge angiocatheter placed under endoscopic view with minimal or no dilationof the tract may improve the short- and long-term stability of the tube.
