Osteoplastic Flap to Approach Frontal Sinus Diseases

The osteoplastic flap (OPF) is a classic surgical technique that provides direct access to the frontal sinus and remains relevant despite advancements in endoscopic approaches. Originally described by Schönborn in 1894 and popularized in the mid-20th century by Montgomery and colleagues, OPF demonstrated high success rates in managing complex frontal sinus pathologies. OPF is indicated in refractory chronic frontal sinusitis, extensive mucoceles, benign and malignant neoplasms, complex frontal trauma, and cases requiring cranialization or combined neurosurgical access. Absolute contraindications include active infection and severe bone pathology, while prior surgery or radiation represent relative contraindications. The procedure involves meticulous preoperative imaging, coronal incision, and elevation of a vascularized bone-pericranial flap to achieve optimal exposure. Although OPF offers excellent anatomic access and favorable healing due to preserved vascularity, limitations such as hypoplastic sinus and inadequate exposure can pose challenges. Potential complications include bone necrosis, cosmetic deformities, mucocele formation, CSF leak, and persistent neuralgia. Despite being largely supplanted by endoscopic techniques, OPF remains an indispensable option for select complex cases where minimally invasive approaches are inadequate. This review summarizes the indications, surgical technique, advantages, disadvantages, and complications of OPF in the modern era.