Tube Extrusion and Cheese Wiring Five Years Post Dacryocystorhinostomy

Abstract

Objective: Dacrocystorhinostomy (DCR) with silicone tube stenting is a common procedure for congenital nasolacrimal duct obstruction (NLDO). The incidence of congenital NLDO is about 6% in the newborn. The duration the tube is left in place varies depending on surgeon preference. Cheese wiring is one of the tube-related complications when the tube is left behind for a long duration. The term cheese wiring refers to the silicone stent or tubing cutting through soft tissue close to the punctum or canaliculi like wire cuts through cheese.  We present a case of tube extrusion with cheese wiring 5 years post DCR. Methods:             Study Design: Case report             Setting: Tertiary Referral Centre             Patient: One Results: A 16 year old Indian male with congenital bilateral NLDO underwent right and left DCR at ages 9 and 11 respectively. The patient presented with smelly nasal discharge 5 years later to the ENT clinic. On initial examination the right tube was in place but the left tube was not visualized. Nasal endoscopy however revealed that both tubes were still there and were subsequently removed. Conclusion: DCR with silicone intubation is a common practice. Early follow up is essential to prevent complications. If tube extrusion is suspected, early endoscopic examination is essential to confirm it   Keywords: nasolacrimal duct obstruction, dacrocystorhinostomy, tube extrusion, cheese wiring