TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summary below includes the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.
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July 2023
BACKGROUND
With the expansion of endonasal techniques, endoscopic dacryocystorhinostomy (eDCR) has gained popularity over conventional open approaches over the last decade. Prior literature has supported the use of eDCR, with outcomes that are comparable to traditional external approaches. Preservation of the posteriorly based mucosal flap was first described by Wormald in a 2002 prospective cohort study, with success rates approaching 96%. Other case series with mucosal flap preservation published shortly thereafter also reported success rates ranging from 90%–96%. Other reports in cohorts without mucosal preservation have shown similar efficacy, however, suggesting that mucosal preservation may not be essential in achieving long-term successful outcomes. This Best Practice review seeks to answer whether eDCR outcomes differ with or without the preservation of mucosal flaps.
BEST PRACTICE
Although the number of randomized control trials (RCTs) is lacking, the current literature suggests mucosal flap preservation may improve outcomes following eDCR. Mucosal preservation may help best in the immediate postoperative period, as it is associated with decreased granulation tissue and synechia. With regard to long-term outcomes, however, one RCT demonstrated improved outcomes whereas other studies have shown no statistical difference. This difference may be attributed to the high success rate of eDCR regardless of the technique used. Higher-powered studies with larger cohorts are needed to elucidate these findings.