Options for retrieving Crawford stents
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This is Richard Allen at the University of Iowa. This video demonstrates retrieval of a Crawford stent with a hook as well as a groove director. The patient has a history of a congenital nasolacrimal duct obstruction. The Crawford stent is placed through the upper punctum and canaliculus. The stent is then rotated and advanced down the nasolacrimal duct. Retrieval with the Crawford hook is then demonstrated with my finger as the stent. The hook is placed along the lateral side of the nose, lateral to the stent. Sweeping the hook medially should allow a metal on metal feeling of the stent. The hook is then rotated to engage the stent and retrieve it from the nose. It is important to be lateral to the stent along the lateral side of the nose.
Another instrument used in retrieval of the Crawford stent is the groove director. The groove director should be placed in the same fashion as the Crawford hook. However, the stent must be pulled superiorly for the olive tip to fall into the groove. The groove director is then withdrawn which results in engagement of the olive tip in the end of the groove director. Again, the groove director is lateral to the stent along the lateral side of the nose.
This is demonstrated endoscopically. The stent is visualized and the groove director is placed lateral to the stent. The groove is now rotated to face the stent and pivoted medially where a metal on metal feeling is noted. The stent is withdrawn slowly so that the olive tip is felt to fall into the groove. The groove director is now withdrawn with the olive tip sliding in the groove until it engages the tip of the groove director so that the stent can be withdrawn from the nose. This maneuver takes practice to master.
