Breakage of the Ritleng Tip Within the Interosseous Nasolacrimal Ductus During Monoka Silastic Stent Intubation and its Management


Journal of Maxillofacial and Oral Surgery, 2022 (ESCI) identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2022
  • Doi Number: 10.1007/s12663-022-01719-0
  • Journal Name: Journal of Maxillofacial and Oral Surgery
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus
  • Keywords: Epiphora, Monoka, Primary probing, Ritleng, Silastic stent, OBSTRUCTION, TUBES
  • Kayseri University Affiliated: No


© 2022, The Association of Oral and Maxillofacial Surgeons of India.A woman was admitted with complaints of severe watering and discharge in the right eye for 3 years. Lacrimal lavage revealed nasolacrimal ductus stenosis and the planning was Monoka stent intubation by using a Ritleng steel probe. We aimed to report for the first time the surgical manipulation of a fractured steel tip of a Ritleng probe within the interosseous nasolacrimal ductus. The inserted metal probe reached into the inferior meatus and the stent was implanted. After the removal of the probe, it was observed that distal thin part of the probe’s tip was broken off and missing. The implanted stent was removed and the surgery was converted to external dacryocystorhinostomy. The tip was not found in the sac and, therefore, perioperative imaging was obtained with a portable X-ray and the fractured probe tip was localized. Under the guidance of anatomical bone structures, the steel tip was detected within the interosseous nasolacrimal ductus. The tip was pulled towards the sac with the help of a magneton and the operation was terminated in a routine fashion. We shared our experience on how an unforeseen event is manipulated and handled that may happen to any oculoplastic surgeon.