Hostname: page-component-5db58dd55d-jhf8m Total loading time: 0 Render date: 2026-05-30T20:26:40.440Z Has data issue: false hasContentIssue false
  • English
  • Français

Mucosal healing with lacrimal and double mucosal flaps endoscopic dacryocystorhinostomy – comparison with flap sacrificed technique: randomised, controlled study

Published online by Cambridge University Press:  13 December 2021

E Ciğer  and
A İşlek Open the ORCID record for A İşlek [Opens in a new window]
E Ciğer
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Kâtip Çelebi University, Atatürk Training and Research Hospital, Izmir, Turkey
A İşlek*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Acıbadem Eskişehir Hospital, Turkey
*
Author for correspondence: Dr A İşlek, Eskişehir Acibadem Hospital, Eskibağlar, Hoşnudiye Mah, Acıbadem Sk., No. 19., Tepebaşı 26170, Eskişehir, Turkey E-mail: drakifislek@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This study aimed to compare two endoscopic dacryocystorhinostomy techniques: lacrimal and double nasal mucosal flaps, and endoscopic dacryocystorhinostomy without flap preservation.

Method

This study was designed as a prospective randomised, controlled trial. Mucosal healing, granulation tissue formation and mucosal scar contracture were investigated after the surgery.

Results

Ninety patients were included in the study (lacrimal and double nasal mucosal flaps, 46; endoscopic dacryocystorhinostomy without flap preservation, 44). Nine (18.8 per cent) patients in the endoscopic dacryocystorhinostomy without flap preservation group and two patients (4.2 per cent) in the lacrimal and double nasal mucosal flaps group had inadequate wound healing (p = 0.025). Granulation tissue formation was detected in nine patients (18.8 per cent) in the endoscopic dacryocystorhinostomy without flap preservation group and in 1 patient (2.1 per cent) in the lacrimal and double nasal mucosal flaps group (p = 0.008). Functional success rates in the endoscopic dacryocystorhinostomy without flap preservation and lacrimal and double nasal mucosal flaps groups were 89.6 per cent and 97.9 per cent, respectively (p = 0.092). The operation time was similar in both groups (p = 0.122).

Conclusion

The double mucosal flaps technique is a surgical procedure with satisfactory outcomes for the repair of mucosal defects and related issues.

Keywords

DacryocystorhinostomyNasolacrimal DuctSurgical FlapsLacrimal Duct ObstructionNasal MucosaGranulation TissueWound Healing

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 12 , December 2022 , pp. 1189 - 1195
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Dr A İşlek takes responsibility for the integrity of the content of the paper

References

Ali, MJ. Psaltis, AJ. Murphy, J. Wormald, PJ. Powered endoscopic dacryocystorhinostomy: a decade of experience. Ophthalmic Plast Reconstr Surg 2015;31:219–21CrossRefGoogle ScholarPubMed
Ali, MJ. Psaltis, AJ. Bassiouni, A. Wormald, PJ. Long-term outcomes in primary powered endoscopic dacryocystorhinostomy. Br J Ophthalmol 2014;98:1678–80CrossRefGoogle ScholarPubMed
McDonogh, M. Meiring, JH. Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol 1989;103:585–7CrossRefGoogle ScholarPubMed
Onerci, M. Dacryocystorhinostomy. Diagnosis and treatment of nasolacrimal canal obstructions. Rhinology 200;40:49–65Google Scholar
Jawaheer, L. MacEwn, C. Anijeet, D. Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database of Systematic Rev 2017;(2):CD007097Google ScholarPubMed
Keren, S. Abergel, A. Manor, A. Rosenblatt, A. Koenigstein, D. Leibovitch, I et al. Endoscopic dacryocystorhinostomy: reasons for failure. Eye 2020;34:948–53CrossRefGoogle ScholarPubMed
Leong, SC. MacEwen, CJ. White PS. A systematic review of outcomes after dacryocystorhinostomy in adults. Am J Rhinol Allergy 2010;24:81–90CrossRefGoogle ScholarPubMed
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;147:782–7CrossRefGoogle ScholarPubMed
Schulz, KF. Altman, DG. Moher, D. Consort Group. Consort 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials. 24;11:32Google Scholar
Kim, DH. Kim, SI. Jin, HJ. Kim, S. Hwang, SH. The clinical efficacy of silicone stents for endoscopic dacryocystorhinostomy: a meta-analysis. Clin Exp Otorhinolaryngol 2018;11:151–7CrossRefGoogle ScholarPubMed
Önerci, M. Orhan, M. Öǧretmenoǧlu, O. Irkeç, M. Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy. Acta Otolaryngol 2000;120:319–22Google ScholarPubMed
Janakiram, TN. Suri, N. Sharma, SB. Modified approach to powered endoscopic dacryocystorhinostomy. J Laryngol Otol 2016;130:261–4CrossRefGoogle ScholarPubMed
Majumder, A. Singh, M. Das, C. Das, S. Hazra, TK. Endonasal dacryocystorhinostomy with mucosal flaps: our experience. Indian J Otolaryngol Head Neck Surg 2013;65:371–5CrossRefGoogle ScholarPubMed
Dave, TV. Mohammed, FA. Ali, MJ. Naik, MN. Etiologic analysis of 100 anatomically failed dacryocystorhinostomies. Clin Ophthalmol 2016;10:1419–22Google ScholarPubMed
Kumar, S. Mishra, AK. Sethi, A. Mallick, A. Maggon, N. Sharma, H et al. Comparing outcomes of the standard technique of endoscopic DCR with its modifications: a retrospective analysis. Otolaryngol Head Neck Surg 2019;160:347–54CrossRefGoogle ScholarPubMed
Green, R. Gohil, R. Ross, P. Mucosal and lacrimal flaps for endonasal dacryocystorhinostomy: a systematic review. Clin Otolaryngol 2017;42:514–20CrossRefGoogle ScholarPubMed
Ciğer, E. Balci, MK. Arslanoğlu, S. Eren, E. Endoscopic-powered dacryocystorhinostomy without stenting: long-term outcomes of 120 procedures. Am J Rhinol Allergy 2018;32:303–9CrossRefGoogle ScholarPubMed
Kingdom, TT. Barham, HP. Durairaj, VD. Long-term outcomes after endoscopic dacryocystorhinostomy without mucosal flap preservation. Laryngoscope 2020;130:12–7CrossRefGoogle ScholarPubMed
Orsolini, MJ. Schellini, SA. Souza Meneguim, RLF. Catâneo, AJM. Success of endoscopic dacryocystorhinostomy with or without stents: systematic review and meta-analysis. Orbit (London) 2020;39:258–65CrossRefGoogle ScholarPubMed
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;36:555–9CrossRefGoogle ScholarPubMed
Liang, J. Lane, A. Is postoperative stenting necessary in endoscopic dacryocystorhinostomy? Laryngoscope 2013;123:2589–90CrossRefGoogle ScholarPubMed
Longari, F. Dehgani Mobaraki, P. Ricci, AL. Lapenna, R. Cagini, C. Ricci, G. Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study. Eur Arch Otorhinolaryngol 2016;273:2079–84CrossRefGoogle ScholarPubMed
Kang, MG. Shim, WS. Shin, DK. Kim, JY. Lee, JE. Jung, HJ. A systematic review of benefit of silicone intubation in endoscopic dacryocystorhinostomy. Clin Exp Otorhinolaryngol 2018;11:81–8CrossRefGoogle ScholarPubMed
Çukurova, I. Caner Mercan, G. Çetinkaya, E. Gümüsssoy, M. Söken, H. Endoscopic dacryocystorhinostomy: outcomes using mucosal flap preserving technique. Eur Arch Otorhinolaryngol 2013;270:1661–6CrossRefGoogle ScholarPubMed
Pradhan, P. Bhardwaj, A. Mandal, S. Majhi, S. Double posterior based flap technique in primary endoscopic dacryocystorhinostomy with and without using powered instrument. Indian J Otolaryngol Head Neck Surg 2017;69:474–9CrossRefGoogle ScholarPubMed
Yuen, KSC. Lam, LYM. Tse, MWY. Chan, DDN. Wong, BWC. Chan, WM. Modified endoscopic dacryocystorhinostomy with posterior lacrimal sac flap for nasolacrimal duct obstruction. Hong Kong Med J 2004;10:394–400Google ScholarPubMed
Mueller, SK. Freitag, SK. Lefebvre, DR. Lee, NG. Bleier, BS. Revision eDCR using a superior pedicled mucosal flap. Orbit (London) 2019;38:1–6CrossRefGoogle ScholarPubMed
Massegur, H. Trias, E. Adema, JM. Endoscopic dacryocystorhinostomy: modified technique. Otolaryngol Head Neck Surg 2004;130:39–46CrossRefGoogle ScholarPubMed
Ji, QS. Zhong, JX. Tu, YH. Wu, WC. New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians. Int J Ophthalmol 2012;5:704–7Google ScholarPubMed
Zloto, O. Koval, T. Yakirevich, A. Ben Simon, GJ. Weissman, A. Ben Artsi, E et al. Endoscopic dacryocystorhinostomy with and without mucosal flap—is there any difference? Eye 2020;34:1449–53CrossRefGoogle ScholarPubMed
Wang, D. Fang, P. Zhao, Y. Assessment of long-term outcomes associated with a lobulated pedicled nasal mucosa flap technique for endoscopic dacryocystorhinostomy without stenting. Ear. Nose Throat J 2020;100(suppl 5):618–23CrossRefGoogle ScholarPubMed
Watelet, JB. Bachert, C. Gevaert, P. Van Cauwenberge, P. Wound healing of the nasal and paranasal mucosa: a review. Am J Rhinol 2002;16:77–84CrossRefGoogle ScholarPubMed
Ali, MJ. Wormald, PJ. Psaltis, AJ. The dacryocystorhinostomy ostium granulomas: classification. indications for treatment. management modalities and outcomes. Orbit 2015;34:146–51CrossRefGoogle ScholarPubMed
Mueller, SK. Freitag, SK. Lefebvre, DR. Bleier, BS. Endoscopic DCR using bipedicled interlacing mucosal flaps. Laryngoscope 2018;128:794–7CrossRefGoogle ScholarPubMed