This is Richard Allen at the University of Iowa. This video demonstrates a procedural variation of a Jones tube placement that I call a “crescent twist”. The caruncle is excised with Westcott scissors. An 18 gauge MVR blade is then placed through the inferior posterior portion of the defect and advanced in an inferior posterior direction. A straightened crescent blade or 66 Beaver blade is then place over the MVR blade, sliding along its surface. The crescent blade is then twisted to enlarge the passage way and removed. A Quickert-Dryden probe is then placed through the fistula. The blade and probe are visualized in the nose and placed in appropriate position. A hemostat is placed over the MVR blade at the entry of the fistula and it is removed. This allows measurement of the length of the Jones tube needed. The Jones tube is then placed over the Quicker-Dryden probe and the probe is removed. Externally, the Jones tube appears to be in good position. Intranasally, the tube is in good position with adequate room between it and the middle turbinate and the nasal septum.