Beyond endoscopy: the ongoing role of frontal osteoplastic flap surgery—a case series and evidence-based analysis

Frontal sinus surgery is among the most technically demanding areas in rhinology due to the complex anatomy of the frontal recess and proximity to critical structures such as the orbit and anterior cranial fossa. Although endoscopic sinus surgery (ESS) is the standard for most sinonasal pathologies, the frontal osteoplastic flap (OPF) remains important in select clinical scenarios. To evaluate the role of OPF in current rhinologic practice by presenting a retrospective case series and reviewing contemporary literature. A retrospective analysis was conducted on 11 patients who underwent OPF between 2007 and 2019 at a Portuguese center. Surgical data, indications, approaches, and outcomes were reviewed. A literature review was also performed to contextualize findings. The most common indications were frontal sinus osteomas, mucoceles with orbital involvement, and refractory chronic frontal sinusitis. Supraciliary and bicoronal incisions were used, and in some cases, combined with ESS. No major complications occurred, and outcomes were highly satisfactory both functionally and esthetically. Despite advancements in endoscopic techniques, OPF remains a valuable option for anatomically challenging, recurrent, or bone-involving frontal sinus disease. This case series and literature review support its continued role in the comprehensive surgical armamentarium in rhinology.