The nasal mucosa is sacrificed in conventional endoscopic dacryocystorhinostomies (EDCRs). Some surgeons, however, modify the technique by elevating a mucosal flap prior to creating the osteotomy with the aim of preserving the mucosa. To our knowledge, no clear-cut benefit of a mucosal flap has been established. The aim of this study is to examine the differences in surgical techniques and success rates of EDCRs with and without mucosal flap preservation.
We carried out a medical record review of all patients who underwent primary EDCR at the Goldschleger Eye Institute from October 2009 to October 2017. The following data were retrieved from the medical database and analyzed: patient demographics (age at diagnosis and gender), medical history, examination findings, surgical details, postoperative success, complications, and follow-up.
A total of 107 patients who underwent 117 EDCRs participated in the study. Fifty-one patients comprised the group without a mucosal flap and 56 patients comprised the group with mucosal flap preservation. The medical history, presenting complaints, and preoperative examination findings were similar for both groups. The surgical success rate was not significantly different between the groups (82.1% without flap vs. 86.8% with flap, P = 0.478, Chi-square).
The findings of this comparison of EDCRs with and without mucosal flap preservation in a large patient population revealed no differences in surgical success or complications rates between the two procedures and, therefore, no benefit for adding flap preservation to conventional EDCRs.
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Caldwell GW. Two new operations for obstruction of the nasal duct, with preservation of the canaliculi, and with an incidental description of a new lachrymal probe. Am J Ophthalmol. 1893;10:189–93.
Totti A. Nuovo Metodo conservatore dicura radicale delle suppurazione croniche del sacco lacrimale (dacricistorhinostomia). Clin Mod (Firenza). 1904;10:385
Cukurova I, Bulgurcu S, Arslan IB, Dikilitas B. Comparison of piezosurgery and hammer-chisel in endoscopic dacryocystorhinostomy. J Craniofac Surg. 2018;29:1612–3.
Selig YK, Biesman BS, Rebeiz EE. Topical application of mitomycin-C in endoscopic dacryocystorhinostomy. Am J Rhinol. 2000;14:205–7.
Cokkeser Y, Evereklioglu C, Tercan M, Hepsen IF. Hammer-chisel technique in endoscopic dacryocystorhinostomy. Ann Otol Rhinol Laryngol. 2003;112:444–9.
Ovet G, Sakarya Y, Senturk M. A comparative study of transcanalicular diode laser supported endoscopic dacryocystorhinostomy and non-laser endoscopic dacryocystorhinostomy. Am J Otolaryngol. 2016;37:497–501.
Cokkeser Y, Evereklioglu C, Er H. Comparative external versus endoscopic dacryocystorhinostomy: results in 115 patients (130 eyes). Otolaryngol Head Neck Surg. 2000;123:488–91.
Lin GC, Brook CD, Hatton MP, Metson R. Causes of dacryocystorhinostomy failure: external versus endoscopic approach. Am J Rhinol Allergy. 2017;31:181–5.
Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology. 2005;112:1463–8.
Tsirbas A, Wormald PJ. Endonasal dacryocystorhinostomy with mucosal flaps. Am J Ophthalmol. 2003;135:76–83.
Trimarchi M, Giordano Resti A, Bellini C, Forti M, Bussi M. Anastomosis of nasal mucosal and lacrimal sac flaps in endoscopic dacryocystorhinostomy. Eur Arch Otorhinolaryngol. 2009;266:1747–52.
Codere F, Denton P, Corona J. Endonasal dacryocystorhinostomy: a modified technique with preservation of the nasal and lacrimal mucosa. Ophthalmic Plast Reconstr Surg. 2010;26:161–4.
Marcet MM, Kuk AK, Phelps PO. Evidence-based review of surgical practices in endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction and other new indications. Curr Opin Ophthalmol. 2014;25:443–8.
Zilelioglu G, Tekeli O, Ugurba SH, Akiner M, Akturk T, Anadolu Y. Results of endoscopic endonasal non-laser dacryocystorhinostomy. Doc Ophthalmol. 2002;105:57–62.
Tsirbas A, Wormald PJ. Mechanical endonasal dacryocystorhinostomy with mucosal flaps. Otolaryngol Clin North Am. 2006;39:1019–36.
Green R, Gohil R, Ross P. Mucosal and lacrimal flaps for endonasal dacryocystorhinostomy: a systematic review. Clin Otolaryngol. 2017;42:514–20.
Mak ST, Io IY, Wong AC. Prognostic factors for outcome of endoscopic dacryocystorhinostomy in patients with primary acquired nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol. 2013;251:1361–7.
Onerci M, Orhan M, Ogretmenoglu O, Irkec M. Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy. Acta Otolaryngol 2000;120:319–22.
Hodgson N, Bratton E, Whipple K, et al. Outcomes of endonasal dacryocystorhinostomy without mucosal flap preservation. Ophthalmic Plast Reconstr Surg. 2014;30:24–27.
Ji QS, Zhong JX, Tu YH, Wu WC. New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians. Int J Ophthalmol. 2012;5:704–7.
Khalifa MA, Ragab SM, Saafan ME, El-Guindy AS. Endoscopic dacryocystorhinostomy with double posteriorly based nasal and lacrimal flaps: a prospective randomized controlled trial. Otolaryngol Head Neck Surg. 2012;147:782–7.
Kansu L, Aydin E, Avci S, Kal A, Gedik S. Comparison of surgical outcomes of endonasal dacryocystorhinostomy with or without mucosal flaps. Auris Nasus Larynx. 2009;36:555–9.
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Zloto, O., Koval, T., Yakirevich, A. et al. Endoscopic dacryocystorhinostomy with and without mucosal flap—is there any difference?. Eye 34, 1449–1453 (2020). https://doi.org/10.1038/s41433-019-0716-4
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