{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:31:49Z","timestamp":1777386709257,"version":"3.51.4"},"reference-count":39,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T00:00:00Z","timestamp":1716768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Rhinol\ufffdAllergy"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n\u2009=\u20099 studies; n\u2009=\u2009191 patients in aggregate) and NLD-involving (n\u2009=\u200910 studies; n\u2009=\u2009296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 \/ 296). Spontaneous resolution of symptoms was common (60%-100% cases).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19458924241249802","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T02:13:07Z","timestamp":1716862387000},"page":"282-293","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Management of the Nasolacrimal Duct in Expanded Endoscopic Approaches to the Maxillary Sinus: A Systematic Review with Evidence-based Recommendations"],"prefix":"10.1177","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6217-8451","authenticated-orcid":false,"given":"Neal Rajan","family":"Godse","sequence":"first","affiliation":[{"name":"Section of Rhinology & Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satyan","family":"Sreenath","sequence":"additional","affiliation":[{"name":"Division of Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology \u2013 Head and Neck Surgery, Indiana University, Indianapolis, IN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian C.","family":"Lobo","sequence":"additional","affiliation":[{"name":"Division of Rhinology & Skull Base Surgery, Department of Otolaryngology \u2013 Head and Neck Surgery, University of Florida, Gainesville, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raj","family":"Sindwani","sequence":"additional","affiliation":[{"name":"Section of Rhinology & Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,5,27]]},"reference":[{"key":"bibr1-19458924241249802","first-page":"526","volume":"58","author":"Caldwell G","year":"1893","journal-title":"N Y Med J"},{"key":"bibr2-19458924241249802","first-page":"401","volume":"23","author":"Moure EJ","year":"1902","journal-title":"Rev Laryngol Otol Rhinol (Bord)"},{"key":"bibr3-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-197401000-00026"},{"key":"bibr4-19458924241249802","volume-title":"Ein neuer Weg f\u00fcr die Operation der malignen Nasentumoren","author":"Denker A","year":"1906"},{"key":"bibr5-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1177\/019459989511200412"},{"key":"bibr6-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199508000-00015"},{"key":"bibr7-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26237"},{"key":"bibr8-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215120000882"},{"key":"bibr9-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1177\/014556130508400403"},{"key":"bibr10-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1017\/S002221510999260X"},{"key":"bibr11-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200305000-00017"},{"key":"bibr12-19458924241249802","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2012.26.3791"},{"key":"bibr13-19458924241249802","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0366-6999.20121754"},{"key":"bibr14-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21640"},{"key":"bibr15-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1564057"},{"key":"bibr16-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21863"},{"key":"bibr17-19458924241249802","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26237"},{"key":"bibr18-19458924241249802","unstructured":"Oxford Levels of Evidence Working Group. \u201cThe Oxford 2011 Levels of Evidence.\u201d Oxford Centre for Evidence-Based Medicine. http:\/\/www.cebm.net\/index.asp?o=5653. 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