Fig. 45 The anterior flaps of the lacrimal sac and nasal mucosa are closed with interrupted absorbable sutures. The periosteum is closed in a similar fashion. A Silastic catheter and nasal packing can be used to separate the anterior and posterior flaps, but the Silastic tubing with the cuff in place has advantages; it can remain in place almost indefinitely in an adult, and it is cosmetically invisible.