Autologous Fat Versus Hydroxyapatite Cement for Use in Frontal Sinus Obliteration: Systematic Review and...

Frontal sinus obliteration remains a treatment option for chronic sinusitis, trauma, or tumors. Surgeons use autologous fat or hydroxyapatite cement (HAC) to fill the sinus space. Prior research has shown that both materials are used clinically, but the evidence comparing their outcomes is limited. This gap motivated a systematic review to evaluate the comparative safety and effectiveness of these two materials. No prior work had resolved whether one material consistently leads to better outcomes than the other. The need for a comprehensive synthesis of available data is clear. Existing studies report various outcomes, but their findings are not always consistent. This uncertainty drives the need for a meta-analysis to clarify the comparative performance of autologous fat and HAC. Surgeons require evidence-based guidance to choose between these materials. The current literature lacks a definitive answer to this question.

This study aimed to compare the outcomes of frontal sinus obliteration using autologous fat versus hydroxyapatite cement (HAC). The specific problem addressed is the lack of clarity regarding which material is superior in terms of safety and effectiveness. The motivation stems from the need to guide clinical decision-making in sinus surgery. The authors sought to synthesize available evidence to inform surgeons about material choice. The study focused on outcomes such as infection rates, mucocele formation, and revision needs. No prior work had resolved whether one material consistently outperforms the other. The authors aimed to provide a balanced view of the risks and benefits of each material. This review and meta-analysis sought to clarify whether surgeon preference should drive material selection.

The researchers conducted a systematic review across multiple databases to collect data on frontal sinus obliteration outcomes. They included studies reporting outcomes for patients who underwent obliteration with either autologous fat or HAC. The outcomes analyzed included infection, mucocele formation, and revision rates. Data were synthesized using meta-analysis of proportions to estimate prevalence. The authors identified 20 eligible studies for inclusion in the analysis. Sixteen studies provided data on autologous fat, and seven on HAC. The meta-analysis compared the prevalence of various complications between the two groups. The authors used statistical methods to assess whether differences were significant.

The meta-analysis found no statistically significant differences in infection rates between autologous fat and HAC. Mucocele formation also showed no significant difference between the two materials. Skin infection at the operative site was similarly reported in both groups. Hematoma or seroma prevalence did not differ between the cohorts. Cosmetic defects were equally likely with either material. Donor site infection from fat harvesting was rare, with a prevalence of less than 0.01. Revision rates were 0.04 for autologous fat and 0.10 for HAC, but the difference was not statistically significant. These findings suggest that both materials perform similarly in terms of safety and effectiveness.

The authors concluded that autologous fat and hydroxyapatite cement (HAC) are equally suitable for frontal sinus obliteration. No statistically significant differences were detected in the studied outcomes between the two materials. The findings suggest that material choice may be left to surgeon preference. The authors propose that both materials have comparable safety profiles. The lack of significant differences implies that neither material is clearly superior. The authors emphasize the importance of individual surgeon experience and patient-specific factors. The results do not support a preference for one material over the other. The authors suggest that further studies may explore long-term outcomes or patient-reported satisfaction.