The role of the osteoplastic flap in the endoscopic era: a retrospective multicentre experience on revision surgery

Abstract

SUMMARY Objective To retrospectively review the experience of five tertiary-care university hospitals on frontal sinus revision surgery with osteoplastic flap (OPF). Methods Descriptive analysis of patients who underwent frontal sinus surgery with OPF after one or more endoscopic procedures for benign and inflammatory pathologies from 2000 to 2022. Clinical charts were reviewed for demographics, indications, clinical presentation, previous frontal procedures, OPF technique and outcomes. Results Of the 124 patients who underwent an OPF procedure, 33 met inclusion criteria. With a mean of 2.1 previous endoscopic surgeries, Draf III was the most common former procedure. In 30 (91%) cases OPF was part of a combined procedure. The most common indications were inverted papilloma (61%), mucocele (9%) and chronic rhinosinusitis (6%). Frontal outflow stenosis (36%) and mucocele (9%) were the most frequent complications observed. Improvement of overall symptoms and patient satisfaction after the OPF procedure were recorded. Conclusions Even in the endoscopic era, OPF still represents a paramount procedure that should be included in the rhino-surgeon’s armamentarium, in particular in patients with challenging pathologies and anatomy when previous endoscopic endonasal attempts have failed.

“Open-window” craniectomy for the removal of frontal sinus mucosa to prevent a delayed mucocele: illustrative case

“…[1][2][3][4]8 No universally accepted management technique exists, with endoscopic marsupialization; obliteration with fat, fascia, muscle, pericranial flap, acellular dermal matrix, bone, hydroxyapatite cement, or methyl methacrylate; and cranialization with staged cranioplasty as prior reported procedures for frontal sinus mucocele. 2,12,[17][18][19][20][21][22][23][24][25][26][27][28] Courson et al, 8 in 2014, reported on trends in the management of frontal sinus mucoceles across 1975-2012 and noted the increasing adoption of endoscopic techniques with similar complication and recurrence rates. A 2023 systematic review reported no differences across clinical outcomes upon comparing autologous fat versus hydroxyapatite cement for frontal sinus obliteration.…”