The place of the osteoplastic flap in the endoscopic era: indications and pitfalls

To evaluate the osteoplastic flap (OPF) procedure for frontal sinus pathology at our institution, including indications, revisions, obliteration vs. nonobliteration, and obliteration materials.

Single-institution retrospective review from 1998 to 2013.

Current Procedural Terminology codes identified all OPF procedures. Demographic data, diagnoses, previous frontal procedures, obliteration materials, and outcomes were evaluated. Diagnoses were divided into two groups: inflammatory (refractory sinusitis, mucoceles, surgical material infections) and noninflammatory (tumors, cerebrospinal fluid leaks).

Fifty-seven patients underwent 73 OPF procedures: 36 obliterative and 37 nonobliterative/unobliterative. Inflammatory indications accounted for 76% of obliterated patients, but only 38% of nonobliterative procedures. Ten patients (17.5%) required revision, 90% of whom had an OPF for inflammatory indications. Only one patient who underwent an OPF procedure for noninflammatory pathology required revision. Twenty-four percent of patients obliterated with bone cement ultimately required complete removal to resolve infection.

The OPF approach is still valuable for pathology refractory to or inaccessible to endoscopic approaches. Infectious etiologies have a much higher revision rate. Careful selection of pathologies can reduce revision rates, but in some cases a repeated OPF procedure is the only viable alternative. When bone cement becomes infected the only resolution is complete removal.