Indications and Outcomes of the Osteoplastic Flap Procedure With or Without Obliteration

Objective: To describe the osteoplastic approach and to perform a systematic review of the indications and outcomes of the osteoplastic flap procedure for frontal sinus surgeries with or without obliteration. Data sources: PubMed, Medline, Google Scholar, and Cochrane databases. Review methods: All published studies in the English language on the osteoplastic flap with or without obliteration were identified from 1905 to 2018. All studies with \u3c20 patients were excluded. The number of patients, technique, indications, follow-up period, symptom relief, revision rates, and complications were recorded and analyzed. Results: A systematic review yielded 25 series containing 1374 patients for analysis. Indications for surgery included chronic frontal sinusitis, mucoceles, fractures or traumas, osteomas, neoplasms, and cerebrospinal fluid leak. The mean follow-up period ranged from 12.8 to 144 months. The percentage of patients needing revisions for frontal sinus disease was 6.2%. There was a high rate of symptomatic improvement (85.0%) and a low rate of major complications (0.7%). However, minor complications occurred in 19.4% of patients. Conclusion: The osteoplastic flap with or without obliteration has many indications. In an era where endoscopic technique provides excellent access to the frontal sinuses, external approaches remain a useful adjunct, and/or salvage technique. In experienced hands, the osteoplastic flap can yield excellent long-term clinical results, with low rates of complications. Regardless of the surgical approach, long-term follow-up is necessary due to the recurrent nature of frontal sinus disease