Use of an image-guided navigation system for insertion of a Lester-Jones tube in a patient with disturbed orbito-nasal anatomy.

Image-guided navigation systems are increasingly used in orbito-facial surgery where advanced pre-operative image manipulation and intra-operative localisation have proved invaluable. We describe the novel use of one such system for Lester-Jones tube placement to the contralateral nasal space in a 54-year-old man with left nasolacrimal duct obstruction following left rhinectomy, hemi-maxillextomy, radiotherapy and reconstruction for a left sinonasal squamous cell carcinoma. Reconstruction included a vascularised iliac crest graft, titanium mesh implant and polyaryletheretherketone (PEEK) maxillo-orbital implant. Pre-operative image analysis was used to determine the required tube length to extend to the right nasal space. Passive optical tracking facilitated intra-operative localisation of suitable entry and exit sites for the tube to avoid the orbital implants and achieve drainage into the contralateral nasal cavity. Free drainage and good positioning of the tube was confirmed by nasal endoscopy. This case supports a role for image-guided navigation in complex lacrimal surgery, particularly in cases with distorted anatomy.