{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T02:37:59Z","timestamp":1784860679688,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,10,13]],"date-time":"2016-10-13T00:00:00Z","timestamp":1476316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Historically dacryocystorhinostomy (<jats:styled-content style=\"fixed-case\">DCR<\/jats:styled-content>) has been performed externally with very good outcomes. Current literature shows comparable success rates between endonasal and external approaches. A common reason for the failure of a <jats:styled-content style=\"fixed-case\">DCR<\/jats:styled-content> is the reclosure of the nasolacrimal stoma by granulation tissue and synechiae.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective of review<\/jats:title><jats:p>A systematic review and critical evaluation of the evidence relating to the preservation of nasal mucosal flaps in <jats:styled-content style=\"fixed-case\">DCR<\/jats:styled-content> surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Type of review and evaluation method<\/jats:title><jats:p>A systematic review using the consort guidance for review of randomised control trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>A search of the following evidence\u2010based medicine databases was performed: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, Ovid, Medline, <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content> and PubMed. The search was limited to English language articles, and the following key words were used: Endonasal, Endoscopic, Dacryocystorhinostomy, <jats:styled-content style=\"fixed-case\">DCR<\/jats:styled-content>, Mucosal Flaps, between years 1970 and 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The best available evidence was level 1B, comprising two randomised control trials and three comparative studies included in the review. The main outcome measures used were lacrimal irrigation and absence of epiphora. Two of the studies demonstrated a statistically significant benefit of mucosal sparing either with nasal mucosal flaps or with lacrimal flaps. More debridement was needed, and granulation tissue was also seen in the groups without mucosal preservation. There was no difference in surgical complications between a mucosal and non\u2010mucosal\u2010sparing technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The overall quality of current evidence is poor, and there does however appear to be a trend towards improved outcomes and reduced granulation in groups where nasal mucosal and lacrimal flaps were preserved, but this is not clear\u2010cut. There was no evidence of increased complication rates with mucosal\u2010sparing techniques. We recommend that until further good quality research is available we should be performing a mucosal\u2010sparing technique when performing <jats:styled-content style=\"fixed-case\">DCR<\/jats:styled-content> routinely.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12754","type":"journal-article","created":{"date-parts":[[2016,9,23]],"date-time":"2016-09-23T14:07:22Z","timestamp":1474639642000},"page":"514-520","source":"Crossref","is-referenced-by-count":34,"title":["Mucosal and lacrimal flaps for endonasal dacryocystorhinostomy: a systematic review"],"prefix":"10.1111","volume":"42","author":[{"given":"R.","family":"Green","sequence":"first","affiliation":[{"name":"ENT Department Ninewells Hospital Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Gohil","sequence":"additional","affiliation":[{"name":"ENT Department Ninewells Hospital Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5051-5382","authenticated-orcid":false,"given":"P.","family":"Ross","sequence":"additional","affiliation":[{"name":"ENT Department Ninewells Hospital Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,10,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2010.24.3393"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/01676830.2013.842253"},{"key":"e_1_2_8_4_1","first-page":"189","article-title":"Two new operations for the obstruction of the nasal duct with preservation of the canaliculi","volume":"10","author":"Caldwell G.W.","year":"1893","journal-title":"Am. 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