ヌンチャク型シリコーンチューブの下鼻甲介穿孔例

A case of perforated nunchaku-style silicone tube through the inferior nasal turbinate

要約　70歳女性が右鼻涙管閉塞に対してヌンチャク型シリコーンチューブ挿入術を受けた。術直後は通水が良好であったが，2か月後から通水が不良となり，当科を受診した。鼻内視鏡検査で，下鼻甲介下部にチューブが2本穿孔，突出し，穿孔部位に発赤と隆起があった。チューブを抜去した直後に鼻涙管開口部から通水があった。20日後に仮道開口部は閉塞し，抜去から2か月後に鼻涙管開口部からの通水がなくなった。本手術では，通水があっても仮道に挿入されていることがあり，チューブ留置中に通水がなくなった場合にはその可能性が大きい。鼻涙管にチューブを留置する際に内視鏡で確認する必要がある。

Abstract.　A 70-year-old female received nunchaku-style silicone intubation for obstructed nasolacrimal duct in her right eye. The newly created nasolacrimal duct became immediately patent but became obstructed 2 months later. When seen by us,nasal endoscopy showed two tubes perforating through the inferior nasal turbinate. The perforated site was hyperemic and swollen. Removal of the tubes was followed by restored irrigation through the nasolacrimal duct. The opening in the nasal cavity became closed 20 days later. No irrigation could be induced 2 months after removal. This case illustrates that the tube may be wrongly inserted in spite of positive irrigation,particularly when the irrigation becomes from positive to negative while the tube is retained. We advocate endoscopic examination after this surgical modality.