HomePhilippine Journal of Otolaryngology Head and Neck Surgeryvol. 26 no. 2 (2011)

Tube Extrusion and Cheese Wiring Five Years Post Dacryocystorhinostomy

Khairullah Bin Anuar | Balwant Singh Gendeh



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 five years post DCR.
Design: Case report
Setting: Tertiary Referral Center
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 five 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.