DS12 Mini Monoka stent use to preserve the canaliculi of the lacrimal drainage system, during periocular Mohs surgery

Abstract The periocular region presents unique challenges in Mohs micrographic surgery (MMS) for tumour excision due to its proximity to critical structures such as the lacrimal drainage system. Preserving functional and aesthetic integrity is paramount, particularly when addressing tumours near the medial canthus. We wish to raise awareness of the Mini Monoka monocanalicular silicone stent as a novel adjunct in MMS to safeguard the canaliculus of the lacrimal drainage system, reduce postsurgical complications and optimize reconstructive outcomes. We wish to show several cases and consider a video presentation for the method of insertion and removal to help Mohs surgeons preserve the canaliculus. A 45-year-old woman was referred by oculoplastic colleagues with a 5-mm basal cell carcinoma on the left lower eyelid in close proximity to the canaliculus for MMS. Prior to surgery, the Mini Monoka stent was inserted under local anaesthesia through the punctum. The silicone stent was threaded into the lacrimal canaliculus through the punctum, with the external fixation wing positioned securely at the punctal opening to prevent migration, thereby ensuring stability and facilitating the preservation of the canalicular structure during the surgical procedure. Placing the Mini Monoka into the lumen of the canaliculus helps in determining where the canaliculus lies, thus preventing damage to it, which could subsequently lead to scarring of the canaliculus and resultant epiphora. If the canaliculus is inadvertently incised, or if a small part of it is excised due to the proximity of the BCC, then having the Mini Monoka in situ can help maintain the integrity of the canalicular lumen by healing around it. MMS was performed and clearance was achieved after the first stage without entering the canaliculus and disturbing the position of the Mini Monoka. Subsequent oculoplastic reconstruction with a skin graft taken from the upper eyelid helped preserve the lacrimal canaliculus. Damage to the canaliculus, especially in young patients, can lead to long-standing epiphora. The Mini Monoka stent demonstrates significant utility for Mohs surgeons when excising periocular tumours in close proximity to the lacrimal drainage system. Indications for its use include cases involving medial canthal tumours or canalicular involvement, or reconstructive surgeries requiring meticulous preservation of the lacrimal system. Its minimally invasive design ensures effective protection of the canalicular system during tumour excision, reduces complications such as epiphora or canalicular stenosis, and enhances postoperative recovery. By incorporating the Mini Monoka into MMS protocols, surgeons can achieve precise tumour clearance while optimizing both functional and cosmetic outcomes for their patients.