title: The J-Curve for Navigating the Nasolacrimal Outflow Tract.
abstract: OBJECTIVE
  To describe the technique of J-shaped manipulation of the metallic stent for instrument-free intubation of the nasolacrimal outflow tract after dacryocystorhinostomy.
  
  
  METHODS
  The internal diameter of the J-shaped curve placed in the intubation stents was measured and the technique of intubation of the nasolacrimal outflow tract and out the external naris is described. In addition, the anatomic relationships of the nasolacrimal system are illustrated and videographed in relation to the described procedure.
  
  
  RESULTS
  This technique has been used successfully on 75 consecutive endoscopic dacryocystorhinostomy cases. After completion of bony osteotomy and opening of the nasolacrimal sac, the metallic portion of the stent is bent into a J-shaped curved with an average internal diameter of 4 cm. The punctum is then canulated with the metallic stent and directed 2 mm vertically then 8 mm to 10 mm medially along the path of the canalicular system. On entering the osteotomy, the stent is directed inferior and slightly lateral in the direction of the external naris. Gentle advancement with small angle redirection of the stent as needed allows exit through the external naris without using additional instrumentation in the nose.
  
  
  CONCLUSIONS
  The authors present a technique of J-shaped manipulation of the intubation stent allowing navigation of the nasolacrimal outflow tract and exit through the external naris without additional instrumentation. This technique offers advantages over instrument-assisted retrieval of the intubation tube. First, the J-Curve technique is faster than multi-instrument retrieval. Second, less damage is incurred to the mucosa of the lateral nasal wall and/or septum secondary to blind placement of a Crawford hook, hemostat, or grooved director.
authors.affiliation: *Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas; †UT Southwestern School of Medicine, Dallas, Texas; and ‡Ophthalmology Associates, Ft. Worth, Texas, U.S.A.
authors.forename: Deepak
authors.initials: D
authors.lastname: Sobti
authors.forename: Daniel
authors.initials: D
authors.lastname: Walk
authors.forename: Katie
authors.initials: K
authors.lastname: Finnerty
authors.forename: Ronald
authors.initials: R
authors.lastname: Mancini
mesh_terms: D003608:Dacryocystorhinostomy; D020878:Device Removal; D006801:Humans; D007440:Intubation / Q000295:instrumentation / Q000379:methods*; D007767:Lacrimal Duct Obstruction / Q000628:therapy*; D009301:Nasolacrimal Duct; D010027:Osteotomy; D015607:Stents