Mucosal Flap Preservation May Not Be Required for Successful Outcomes with eDCR

by Literature Review •

What are the long-term outcomes after powered endoscopic dacryocystorhinostomy (eDCR) without preservation of mucosal flaps for the acquired naso-lacrimal duct obstruction management?

BOTTOM LINE: Outcomes of powered eDCR without the preservation of mucosal flaps compare favorably to previously reported results in the literature. These long-term results suggest that mucosal flap preservation is not required to achieve successful outcomes with eDCR.

BACKGROUND: DCR is generally well tolerated and successful in relieving epiphora for those with nasolacrimal duct obstruction (NLDO). The use of powered instrumentation combined with mucosal flap preservation has been shown to be highly successful. Several groups report performing this procedure without preservation of mucosal flaps, allowing the mucosa to heal by second intention, with good initial clinical outcomes.

STUDY DESIGN: Retrospective review of 80 patients (69 primary, 11 revision), totaling 103 procedures (87 primary, 16 revision), with epiphora secondary to acquired nasolacrimal duct obstruction who underwent eDCR without mucosal flap preservation from May 2003 to
April 2013.

SETTING: Department of Otolaryngology, the University of Colorado School of Medicine, Aurora, Colorado.

SYNOPSIS: The majority (71) of patients suffered from primary idiopathic acquired NLDO. Five patients had prior surgery for paranasal sinus neoplasm, and four patients had prior radioactive iodine treatment as presumed etiologies for epiphora. At the most recent follow-up, 92 of 103 procedures had complete epiphora resolution, and 10 of 103 procedures achieved mild intermittent epiphora. Analysis by group revealed complete epiphora resolution in 93.1% of primary procedures and 68.8% of revision procedures. A left-sided DCR was performed in 30 patients, a right-sided DCR in 25 patients, and bilateral DCR in 24 patients; silicone lacrimal stents were used in all cases and left in place for an average of three months.

There were no major complications in this series. Minor complications included stent-related complaints in approximately 20% of patients. In the primary eDCR group, there were six revision procedures performed on five sides in five patients to ultimately achieve complete epiphora resolution. Limitations included the review’s retrospective nature, lack of a direct comparison group, and symptoms that are patient reported.

CITATION: Kingdom TT, Barham HP, Durairaj VD. Long-term outcomes after endoscopic dacryocystorhinostomy without mucosal flap preservation. Laryngoscope. 2020;130:12-17. doi: 10.1002/lary.27989.