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Key points: ICA coil extrusion (ICA‐CE) occurs most frequently in the nasopharyngeal/sinonasal site.Evaluating the ICA coils stability, through an angiography, is of primary importance.ICA‐CE management needs to be decided based on the patient's symptoms and general status. [ABSTRACT FROM AUTHOR]

Background: Sinonasal malignancies with orbital invasion have dismal prognosis even when treated with orbital exenteration (OE). Sugawara et al. developed a surgical strategy called "extended‐OE (EOE)," showing encouraging outcomes. We hypothesized that a similar resection is achievable under endoscopic guidance through the exenterated orbit (endoscopic‐EOE). Methods: The study was conducted in three institutions: University of Vienna; Mayo Clinic; University of Insubria; 48 orbital dissections were performed. A questionnaire was developed to evaluate feasibility and safety of each step, scoring from 1 to 10, ("impossible" to "easy," and "high risk" to "low risk," respectively), most likely complication(s) were hypothesized. Results: The step‐by‐step technique is thoroughly described. The questionnaire was answered by 25 anterior skull base surgeons from six countries. Mean, median, range, and interquartile range of both feasibility and safety scores are reported. Conclusions: Endoscopic‐EOE is a challenging but feasible procedure. Clinical validation is required to assess real‐life outcomes. [ABSTRACT FROM AUTHOR]

This article discusses a study on fungal sinus aspergilloma (FSA), a rare condition characterized by the presence of fungal growth in the sinuses. The study included six patients with FSA and found that the frontal sinus was involved in one patient, while bilateral infection was reported in another case. The most common symptom was headache. The study also compared the incidence of bone erosion in FSA with other types of fungal sinusitis and found that FSA had a higher incidence of bone erosion. The authors suggest that recognizing the radiological features of FSA and obtaining tissue samples for analysis are important for accurate diagnosis and treatment planning. [Extracted from the article]

Key points: Nasoseptal flap with extended pedicle dissection is a low morbidity and high success rate flap.It is a flap that can be applied to reconstruct a wide range of ipsilateral skull base defects. [ABSTRACT FROM AUTHOR]

Key Points Intralesional cidofovir injections in combination with surgery is an effective treatment for recurrent multifocal sinonasal exophytic papilloma. No malignant transformation has been observed in our experience. Anosmia is a potential side effect that patients should be aware of. [ABSTRACT FROM AUTHOR]

This article discusses the use of a local flap called the septal nasopharyngeal "kite flap" in the treatment of petrous apex cholesterol granuloma (PACG). PACG is a benign lesion of the temporal bone that can cause symptoms such as headache, hearing loss, and facial paresthesia. The study found that the septal nasopharyngeal "kite flap" is a reliable solution to prevent restenosis of PACG when used in conjunction with an endoscopic trans-pterygoid infra-petrous approach. The flap was found to be effective in preventing recurrence of symptoms and had no major complications. Further research is needed to validate these findings. [Extracted from the article]

Background: Iatrogenic cerebrospinal fluid leak (iCSF-L) is a major complication of endonasal surgeries whose occurrence is always a potential adverse event due to anatomical variation/asymmetry of the skull base (SB). The aim of this manuscript is to provide a topographical map of iCSF-L and to investigate the role of SB asymmetry in iCSF-L occurrence. Methods: In this retrospective study, the location of iCSF-L dural defect was studied and compared to patients affected by spontaneous and post-traumatic CSF-L. Considering only iCSF-L, after having collected the SB asymmetry data, the Keros, Gera, distance of the anterior ethmoidal artery from the SB, frontal sinus pneumatization, and Thailand–Malaysia–Singapore score classifications were compared to a control group of patients. Results: A total of 153 CSF-Ls (103 spontaneous, 37 iatrogenic, and 13 traumatic) were included. A significant association was noted (p < 0.001) between the nature of the CSF-L and the areas involved. Considering iCSF-Ls, only the Gera classification was significantly different (p < 0.05) and the most reliable in predicting the risk of dural transgression (AUC = 0.719). Conclusions: ICSF-Ls present peculiar regional SB involvement with the cribriform plate, with the ethmoidal roof being the most involved. After having assessed the asymmetry of the SB, the Gera classification was the most reliable one. [ABSTRACT FROM AUTHOR]

Inversion of time‐lapse electrical resistivity tomography is an extension of the conventional electrical resistivity tomography inversion that aims to reconstruct resistivity variations in time. This method is widely used in monitoring subsurface processes such as groundwater evolution. The inverse problem is usually solved through deterministic algorithms, which usually guarantee a fast solution convergence. However, the electrical resistivity tomography inverse problem is ill‐posed and non‐linear, and it could exist more than one resistivity model that explains the observed data. This paper explores a Bayesian approach based on data assimilation, the ensemble smoother multiple data assimilation. In particular, we apply an adaptive approach in which the inflation coefficient is chosen based on the error function, that is the ensemble smoother multiple data assimilation restricted step. Our inversion approach aims to invert the data acquired at two different times simultaneously, estimating the resistivity model and its variation. In addition, the Bayesian approach allows for the assessment of the posterior probability density function needed for quantifying the uncertainties associated with the results. To test the method, we first apply the algorithm to synthetic data generated from realistic resistivity models; then, we invert field data from the Pillemark landfill monitoring station (Samsø, Denmark). Inversion results show that the ensemble smoother multiple data assimilation restricted step can correctly detect the resistivity variation both in the synthetic and in the field case, with an affordable computational burden. In addition, assessing the uncertainties allows us to interpret the reconstructed resistivity model correctly. This paper demonstrates the potential of the data assimilation approach in Bayesian time‐lapse electrical resistivity tomography inversion. [ABSTRACT FROM AUTHOR]

DISCUSSION EPLA extended to the anterior wall of the MS is a feasible technique that, as shown by these preliminary data, can be used as a surgical corridor or a direct treatment for lesions located at the antero-lateral portion of the MS. The maxillary sinus (MS) is then opened through the pre-lacrimal recess, the bony structure around the lacrimal pathway is removed at 360° and transposed medially; a sub-periosteum plane is reached on the anterior MS wall and detached from the bone to the infraorbital nerve (B). Extended Endoscopic Pre-Lacrimal Medial Maxillectomy To the Anterior Maxillary Sinus Wall. [Extracted from the article]

After having endonasal medial maxillectomies pre-lacrimal with lacrimal transposition, the posterosuperior bony wall of the lacrimal pathway, which represents the anterior boundary of the retro-lacrimal recess, is evident, highlighting the feasibility of lesions involving this area. EPLA is a surgical procedure that is gaining popularity; however, the real applicability of this approach is generally related to the anatomy of the MS medial wall and lacrimal pathway. Keywords: functional endoscopic sinus surgery; inverted papilloma; lacrimal transposition; medial maxillectomy; pre-lacrimal approach EN functional endoscopic sinus surgery inverted papilloma lacrimal transposition medial maxillectomy pre-lacrimal approach 2090 2094 5 08/14/23 20230901 NES 230901 EPLA lacrimal transposition facilitates management of maxillary sinus/pterygopalatine fossa lesions and overcomes limitations such as the Simmen type I recess or IPMS pedicled on the medial wall, without increasing peri-operative morbidity. [Extracted from the article]

Keywords: chronic rhinosinusitis; endoscopic sinus surgery; maxillectomy; paranasal sinus diseases EN chronic rhinosinusitis endoscopic sinus surgery maxillectomy paranasal sinus diseases 1051 1054 4 05/29/23 20230601 NES 230601 INTRODUCTION Transnasal endoscopic medial maxillectomies (EMMs) are widely used to treat inverted papilloma of the maxillary sinus (IPMS). Chronic rhinosinusitis, endoscopic sinus surgery, maxillectomy, paranasal sinus diseases The aim of this study was to compare the postoperative pain, nasal symptoms burden, and complications in patients treated with EMM or EPLA for IPMS. [Extracted from the article]

(1) Background: In head and neck squamous cell carcinoma, tumor hypoxia has been associated with radio/chemoresistance and poor prognosis, whereas human papillomavirus (HPV)-positive status has a positive impact on treatment response and survival outcomes. The aim of this study was to evaluate the expression and the potential prognostic value of hypoxia-induced endogenous markers in patients treated for squamous cell carcinoma of the nasal cavity and paranasal sinuses (SNSCC), and their correlation with HPV status. (2) Methods: In this monocentric study, patients treated in a curative intent for a SNSCC were screened retrospectively. Protein expression of CA-IX, GLUT-1, VEGF, VEGF-R1, and HIF-1α was determined by immunohistochemical staining, scored, and then correlated with overall survival (OS) and locoregional recurrence free survival (LRRFS). HPV status was assessed and correlated with hypoxic markers. (3) Results: 40 patients were included. A strong expression of CA-IX, GLUT-1, VEGF, and VEGF-R1 was detected in 30%, 32.5%, 50%, and 37.5% of cases, respectively. HIF-1α was detected in 27.5% of cases. High CA-IX expression was associated in univariate analysis with poor OS (p = 0.035), but there was no significant association between GLUT-1, VEGF, VEGF-R1, and HIF-1α expression, and OS/LRRFS. There was no correlation found between HPV status and hypoxia-induced endogenous markers (all p > 0.05). (4) Conclusions: This study provides data on the expression of hypoxia-induced endogenous markers in patients treated for SNSCC and underlines the potential role of CA-IX as a prognostic biomarker for SNSCC. [ABSTRACT FROM AUTHOR]

This article is a response to a letter discussing the potential use of cidofovir in the treatment of sinonasal squamous papillomas. The authors acknowledge the promise of topical drug approaches in the field of rhinology and highlight other topical treatments that have been explored for various sinonasal conditions. They note that while the case presented in the letter is interesting, longer follow-up is needed to assess the long-term efficacy of topical treatment. Overall, the article provides valuable insights into the potential use of topical cidofovir and emphasizes the need for further research in this area. [Extracted from the article]

Branchial cyst of the second pouch is the most common lesion of the nasopharyngeal lateral wall, generally localized between the pharyngeal wall and internal carotid artery. Cases consistent with such lesion, were collected. Symptomatic patients were treated with endoscopic trans‐nasal marsupialisation, asymptomatic cases were followed‐up. Among the 10 patients included, 4 were symptomatic and accordingly treated. In the literature, 36 cases were found, all of which were treated, most commonly with a total excision. Considering the benign nature of branchial nasopharyngeal cyst, its treatment should be tailored to each patient: endoscopic marsupialization in symptomatic lesion, follow‐up in asymptomatic one. Laryngoscope, 132:1904–1908, 2022 [ABSTRACT FROM AUTHOR]

Objective: Petrous apex cholesterol granuloma (PACG) is a lesion that can give rise to different symptoms, and correlations with etiopathology are ambiguous. The aim of this study is to analyze the association between PACG symptoms and radiological findings at presentation, in order to establish a reproduceable pre-operative radiological evaluation and guide the surgical indication. Methods: PACG patients were collected in two tertiary care hospitals. All cases underwent CT/MRI to evaluate the cyst localization and erosion of surrounding structures. Typical and atypical symptoms were then analyzed and compared to radiologic findings established in accordance with the literature. Results: Twenty-nine patients were recruited; the most common symptoms were headache (69%), diplopia (20.7%) and fainting (24.1%), an atypical clinical manifestation related to jugular tubercle involvement. Significant associations between symptoms and radiologic findings were noted in terms of headache and temporal lobe compression (p = 0.04), fainting and jugular tubercle erosion (p < 0.001), vestibular symptoms and internal auditory canal erosion (p = 0.02), facial paresthesia and Meckel's cave compression (p = 0.03), diplopia and Dorello canal involvement (p = 0.001), and tinnitus and cochlear basal turn erosion (p < 0.001). All patients were treated via an endoscopic–endonasal approach, in which extension was tailored to each case. At a median follow-up of 46 months, 93.1% of patients experienced resolution of symptoms. Conclusions: This clinico-radiological series demonstrates associations between symptoms and anatomical subsites involved with PACG. Hence, it may guide the surgeon at the time of surgical decision, since it asserts that typical and atypical symptoms are actually related to PACG. [ABSTRACT FROM AUTHOR]

Expensive forward model evaluations and the curse of dimensionality usually hinder applications of Markov chain Monte Carlo algorithms to geophysical inverse problems. Another challenge of these methods is related to the definition of an appropriate proposal distribution that simultaneously should be inexpensive to manipulate and a good approximation of the posterior density. Here we present a gradient‐based Markov chain Monte Carlo inversion algorithm that is applied to cast the electrical resistivity tomography into a probabilistic framework. The sampling is accelerated by exploiting the Hessian and gradient information of the negative log‐posterior to define a proposal that is a local, Gaussian approximation of the target posterior probability. On the one hand, the computing time to run the many forward evaluations needed for both the data likelihood evaluation and the Hessian and gradient computation is decreased by training a residual neural network to predict the forward mapping between the resistivity model and the apparent resistivity value. On the other hand, the curse of dimensionality issue and the computational effort related to the Hessian and gradient manipulation are decreased by compressing data and model spaces through a discrete cosine transform. A non‐parametric distribution is assumed as the prior probability density function. The method is first demonstrated on synthetic data and then applied to field measurements. The outcomes provided by the presented approach are also benchmarked against those obtained when a computationally expensive finite‐element code is employed for forward modelling , with the results of a gradient‐free Markov chain Monte Carlo inversion, and also compared with the predictions of a deterministic inversion. The implemented approach not only guarantees uncertainty assessments and model predictions comparable with those achieved by more standard inversion strategies, but also drastically decreases the computational cost of the probabilistic inversion, making it similar to that of a deterministic inversion. [ABSTRACT FROM AUTHOR]

Casting a geophysical inverse problem into a Bayesian setting is often discouraged by the computational workload needed to run many forward modelling evaluations. Here we present probabilistic inversions of electrical resistivity tomography data in which the forward operator is replaced by a trained residual neural network that learns the non‐linear mapping between the resistivity model and the apparent resistivity values. The use of this specific architecture can provide some advantages over standard convolutional networks as it mitigates the vanishing gradient problem that might affect deep networks. The modelling error introduced by the network approximation is properly taken into account and propagated onto the estimated model uncertainties. One crucial aspect of any machine learning application is the definition of an appropriate training set. We draw the models forming the training and validation sets from previously defined prior distributions, while a finite element code provides the associated datasets. We apply the approach to two probabilistic inversion frameworks: A Markov chain Monte Carlo algorithm is applied to synthetic data, while an ensemble‐based algorithm is employed for the field measurements. For both the synthetic and field tests, the outcomes of the proposed method are benchmarked against the predictions obtained when the finite element code constitutes the forward operator. Our experiments illustrate that the network can effectively approximate the forward mapping even when a relatively small training set is created. The proposed strategy provides a forward operator that is three orders of magnitude faster than the accurate but computationally expensive finite element code. Our approach also yields the most likely solutions and uncertainty quantifications comparable to those estimated when the finite element modelling is employed. The presented method allows solving the Bayesian electrical resistivity tomography with a reasonable computational cost and limited hardware resources. [ABSTRACT FROM AUTHOR]

To reduce both the computational cost of probabilistic inversions and the ill‐posedness of geophysical problems, model and data spaces can be reparameterized into low‐dimensional domains where the inverse solution can be computed more efficiently. Among the many compression methods, deep learning algorithms based on deep generative models provide an efficient approach for model and data space reduction. We present a probabilistic electrical resistivity tomography inversion in which the data and model spaces are compressed through deep convolutional variational autoencoders, while the optimization procedure is driven by the ensemble smoother with multiple data assimilation, an iterative ensemble‐based algorithm. This method iteratively updates an initial ensemble of models that are generated according to a previously defined prior model. The inversion outcome consists of the most likely solution and a set of realizations of the variables of interest from which the posterior uncertainties can be numerically evaluated. We test the method on synthetic data computed over a schematic subsurface model, and then we apply the inversion to field measurements. The model predictions and the uncertainty assessments provided by the presented approach are also compared with the results of a Markov Chain Monte Carlo sampling working in the compressed domains, a gradient‐based algorithm and with the outcomes of an ensemble‐based inversion running in the uncompressed spaces. A finite‐element code constitutes the forward operator. Our experiments show that the implemented inversion provides most likely solutions and uncertainty quantifications comparable to those yielded by the ensemble‐based inversion running in the full model and data spaces, and the Markov Chain Monte Carlo sampling, but with a significant reduction of the computational cost. [ABSTRACT FROM AUTHOR]

Background and Objectives: Cocaine users may present with positive antineutrophil cytoplasmic antibodies (ANCA) and severe midline destructive lesions (CIMDL) which are histologically characterized by massive apoptosis. However, histopathological and laboratory studies suggest that autoimmunity may not be the main pathogenic driver. We analyzed gene expression both in cell lines of nasal mucosa exposed to cocaine and in CIMDL patients to determine whether genetic predisposition might cause such lesions, which are observed in a minority of cocaine abusers. Materials and Methods: The genetic expression profile of nasal mucosa exposed to cocaine was analyzed. Rare variants of expressed genes were searched in patients with CIMDL using exome sequencing and bio-informatics. Results: We identified 462 genes that were induced by cocaine, mainly related to apoptosis and autophagy in response to oxidative stress. Under the hypothesis that genes linked to the phenotype are also induced by cocaine itself, a rare variants burden test was performed to select genes that were significantly enriched in rare mutations. Next, 11 cocaine abusers with CIMDL and no other relevant medical comorbidities underwent exome sequencing, and 12 genes that were significantly enriched in the burden test and present in at least 10 patients were identified. An in-depth analysis of these genes revealed their involvement in apoptosis, tissue homeostasis, autophagy, and response to oxidative stress. Conclusions: Oxidative stress and rare genetic alterations in the response to reactive oxygen species, apoptosis, autophagy, and tissue regeneration are plausible drivers of damage affecting nasal mucosa exposed to cocaine crystals and, consequently, the pathogenic mechanism behind CIMDL. [ABSTRACT FROM AUTHOR]

Melanoma of the lacrimal drainage system (LDSM) is a rare and subtle condition that is frequently misdiagnosed. In the present work, we conducted a systematic review investigating the clinical features, management, and prognosis of LDSM. A structured search, according to PRISMA criteria, was performed in April 2020 and updated in February 2021 on Pubmed, EMBASE, Cochrane, and SCOPUS. The articles found underwent a double‐reviewer selection and the main data were extracted. After complete screening, 30 articles reporting 38 cases were included. The time from the first symptom to medical contact ranged from 1 month to 4 years. Surgery was the treatment proposed to all patients, with a variable extension of resection. LDSM is a rare disease that is burdened by poor prognosis. Early diagnosis is crucial, even if difficult to achieve. Surgery and radiotherapy are standardized treatments, while targeted therapy and immunotherapy are attractive prospects. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To estimate the impact of optical techniques on prevention of post‐operative hypocalcemia and hypoparathyroidism after total thyroidectomy. Study Design: Systematic review and meta‐analysis. Methods: A literature search was conducted in Pubmed, EMBASE, SCOPUS, and Cochrane databases. The main inclusion criteria for eligible articles for meta‐analysis were patients with benign or malignant thyroid pathologies who underwent total thyroidectomy, utilization of optical techniques to support PGs preservation, the availability of calcium and/or PTH levels. The primary outcome was to evaluate the variation of calcium and PTH levels when adopting optical technologies compared to standard naked‐eye surgery. Results: In total, 13 papers with 1484 procedures were included. Pooled proportion for short‐ and medium‐term hypocalcemia rates were 8% (95% CI, 5%:11%) and 1% (95% CI, 0%:4%) for optical techniques, while for naked‐eye surgery were 15% (95% CI, 9%:23%) and 5% (95% CI, 2%:9%), respectively. Conclusions: Optical technologies reduced short and medium term hypocalcemia compared to conventional surgery. Level of Evidence: NA Laryngoscope, 131:1683–1692, 2021 [ABSTRACT FROM AUTHOR]

Objective: Endoscopic endonasal dacryocystorhinostomy (END-DCR) has increased as a valid alternative to the classic external approach to treat distal lacrimal obstruction. Different surgical varieties of the END-DCR approach have been proposed with no clear understanding of the best surgical technique. Data Source: A comprehensive research was performed in PubMed, Embase, SCOPUS, and Cochrane databases with a final search on March 2020. Review Methods: The aim of this search was to identify relevant END-DCR procedures performed with mechanical (Mecn-END-DCR) and powered (Pow-END-DCR) approaches to compare their functional success rate. In addition, the influence of mucosal flaps was evaluated. Articles were selected only if they were published later than 2000 and had at least 50 single-clinician surgical procedures performed. Excluded articles included acute infections, cancers, mixed cohort study, and revision cases. Results: A total of 11,445 publications were identified and 2741 reviewed after screening; 15 articles were included after full-text review (0.6% of the initial articles reviewed). The mean success rate was 91.34% (95% CI, 87.1%-94.3%) for Pow-END-DCR and 89.5% (95% CI, 86.5%-91.9%) for Mecn-END-DCR with no significant difference between the surgical approaches (P =.43). For mucosal flaps performed during END-DCR, the mean success rate was 89% (95% CI, 86%-91%) if mucosal flaps were used and 92% (95% CI, 88%-95%) if they were not used, with no statistical difference present (P =.14). Conclusions: Our analyses suggest that there are no differences in outcomes between mechanical and powered approaches in END-DCR and that mucosal flap preservation is not essential to achieve a superior END-DCR outcome. [ABSTRACT FROM AUTHOR]

Treatment options for severe CRSwNP are limited. Dupilumab is a safe, well‐tolerated, and effective alternative in patients with poor control of symptoms, corticosteroid‐dependent disease, and high rates of recurrence of nasal polyps after surgery. [ABSTRACT FROM AUTHOR]

Electrical resistivity tomography is an ill‐posed and nonlinear inverse problem commonly solved through deterministic gradient‐based methods. These methods guarantee a fast convergence towards the final solution, but the local linearization of the inverse operator impedes accurate uncertainty assessments. On the contrary, numerical Markov chain Monte Carlo algorithms allow for accurate uncertainty appraisals, but appropriate Markov chain Monte Carlo recipes are needed to reduce the computational effort and make these approaches suitable to be applied to field data. A key aspect of any probabilistic inversion is the definition of an appropriate prior distribution of the model parameters that can also incorporate spatial constraints to mitigate the ill conditioning of the inverse problem. Usually, Gaussian priors oversimplify the actual distribution of the model parameters that often exhibit multimodality due to the presence of multiple litho‐fluid facies. In this work, we develop a novel probabilistic Markov chain Monte Carlo approach for inversion of electrical resistivity tomography data. This approach jointly estimates resistivity values, litho‐fluid facies, along with the associated uncertainties from the measured apparent resistivity pseudosection. In our approach, the unknown parameters include the facies model as well as the continuous resistivity values. At each spatial location, the distribution of the resistivity value is assumed to be multimodal and non‐parametric with as many modes as the number of facies. An advanced Markov chain Monte Carlo algorithm (the differential evolution Markov chain) is used to efficiently sample the posterior density in a high‐dimensional parameter space. A Gaussian variogram model and a first‐order Markov chain respectively account for the lateral continuity of the continuous and discrete model properties, thereby reducing the null‐space of solutions. The direct sequential simulation geostatistical method allows the generation of sampled models that honour both the assumed marginal prior and spatial constraints. During the Markov chain Monte Carlo walk, we iteratively sample the facies, by moving from one mode to another, and the resistivity values, by sampling within the same mode. The proposed method is first validated by inverting the data calculated from synthetic models. Then, it is applied to field data and benchmarked against a standard local inversion algorithm. Our experiments prove that the proposed Markov chain Monte Carlo inversion retrieves reliable estimations and accurate uncertainty quantifications with a reasonable computational effort. [ABSTRACT FROM AUTHOR]

Background: Epiphora is a common ophthalmologic sign that is most commonly caused by distal acquired lacrimal obstruction. Recent data have demonstrated that external dacryocystorhinostomy (EXT-DCR) and endoscopic endonasal dacryocystorhinostomy (END-DCR) can be considered the treatments of choice. However, different post-surgical medical therapies are available and are currently used to improve surgical outcomes, although no direct comparison has been performed. Objective: To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes. Methods: A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed. Results: In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C. Conclusions: Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries. [ABSTRACT FROM AUTHOR]

Endonasal balloon‐assisted dacryoplasty is a minimally invasive technique that uses a high‐pressure balloon catheter introduced into the lacrimal pathway through the nasal fossa into the neorhinostomy to treat recurrent epiphora after primary dacryocystorhinostomy. This procedure can be considered to be a reliable technique in patients unfit for general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Epiphora is a common clinical sign whose primary cause is post‐canalicular lacrimal obstruction. Treatment is both surgical and non‐surgical. In the literature, there is some evidence to suggest that some treatments are superior to others, but there are no direct comparative data in this regard. Objective of review: To analyse the success rates of all available treatments to resolve post‐canalicular acquired lacrimal obstruction. Type of review: Systematic review and meta‐analysis. Search strategy: A literature search was conducted in the US National Library of Medicine (PubMed), EMBASE, SCOPUS and Cochrane databases with a final search performed in January 2020. Evaluation method: The search strategy identified articles published later than 2000 with at least 50 procedures performed both surgically (external dacryocystorhinostomy [EXT‐DCR], endoscopic dacryocystorhinostomy [END‐DCR] and transcanalicular laser dacryocystorhinostomy [TCL‐DCR]) and non‐surgically (balloon dacryoplasty [DCP], probing‐stenting [SP] and polyurethane stent [PoS]). The primary outcome was functional success, defined as symptom resolution or less than MUNK 2 scale; in addition to this, the influence of adjunctive treatments, such as application of mitomycin C and post‐procedural silicone stenting, was evaluated. Results: In total, 14 958 papers were selected, 440 of which were reviewed after screening; 55 were included after full‐text review, which involved 9337 procedures. Mean success rate was 48.9% (35.7%‐62.3%) for DCP, 54.4% (41.8%‐66.5%) for SP, 73.6% (59.7%‐84%) for PoS, 80% (75.1%‐84%) for TCL‐DCR, 89.8% (83.3%‐93.9%) for EXT‐DCR and 89.5% (87.2%‐91.5%) for END‐DCR. Among all procedures, a difference was noted between DCP and END‐DCR (P <.001), DCP and EXT‐DCR (P <.001), SP and END‐DCR (P <.001), SP and EXT‐DCR (P <.001), END‐DCR and PoS (P =.016), and END‐DCR and TCL‐DCR (P =.001); no differences were noted between END‐DCR and EXT‐DCR (P = 1.00), EXT‐DCR and PoS (P =.121) and EXT‐DCR and TCL‐DCR (P =.223). Considering surgical procedures, no differences were seen if a silicone stenting was applied, whereas, due to heterogeneity of the literature data, no statistical analysis was feasible for application of mitomycin C. Conclusions: Our analyses suggest that, among all procedures available, END‐DCR and EXT‐DCR should be considered as treatments of choice to resolve distal acquired lacrimal obstruction. [ABSTRACT FROM AUTHOR]