Oroantral communication closure using a pedicled buccal fat pad graft

Abstract

Purpose: This paper reports the procedure used to close a late oroantral fistula using rotating flaps of the pedicled buccal fat pad. Case description: A 66-year-old, male patient with leukoderma, in good general health, was referred for closure of an extensive late oroantral communication. Upon clinical examination, an approximately 10-mm fistula was observed connecting the oral cavity to the maxillary sinus. An outpatient surgical procedure was performed with the use of local anesthetics to close the oroantral fistula with a rotating pedicled buccal fat pad flap. The healing of the wound and closure of the defect could be seen after a 30-day postoperative period, with complete epithelialization. Conclusion: Grafting of the pedicled buccal fat pad is thought to be an efficient, safe and easy alternative to a larger oroantral fistula closure. Pedicled buccal fat pad grafting corrected the defect without generating any sequelae and/or great postoperative discomfort to the patient.

Anatomical and Surgical Implications of the Usage of Bichat Fat Pad in Oroantral Communication, Maxillary, Palatal, and Related Surgeries—Narrative Review

“…Uneventful post-operative healing without wound dehiscence, infection, and necrosis was observed after BFP defect closure. Jose et al evaluated the effectiveness of the buccal fat pad in the reconstruction of such surgical defects and reported many successful results after the usage of the BFP with or without mucosal coverage [18][19][20][21][22][23]. This finding confirms that the volume of used BFP not only grants a good amount of surgical tissues but is also vascularized enough to heal in the most difficult surgical conditions.…”

“…Second, the palatal defect heals via granulation, which is also troublesome for the patient. The location on the vestibular sulcus of the maxillary alveolar bone and the large size of the lesion support the choice of the pedicled buccal fat pad flap technique [21]. In some cases of bigger maxillary sinus wall deficiencies, the suturing can be troublesome, especially when it causes severe buccal narrowing or is sutured with tension.…”

“…Various clinical situations can lead to defects in the walls of the paranasal sinuses. Many techniques for defect coverage are known; however, the BFP is considered a very good material for most vertical, horizontal, and combined bone defects in the palatemaxillary area [9,[15][16][17][18][19][20][21][22][23][24][25]. The fat pad can be used in different techniques and alterations.…”

Alternativas cirúrgicas de fechamento de fístula buco sinusal: revisão da literatura

“…Devido à sua boa vascularização, excelente espessura e massa de tecido, fácil acessibilidade, esse retalho é particularmente indicado em casos de insucesso da utilização do retalho bucal (del Rey-Santamaría et al, 2006;Silveira et al, 2008) A técnica envolve a excisão do trajeto da fístula, se presente, e o desenvolvimento de um retalho de espessura total de base ampla, garantindo a inclusão da artéria palatina maior para suprimento sanguíneo adequado e, em seguida, girando o retalho para cobrir a comunicação. A técnica deixa uma área de desnudamento palatino que pode ser deixada exposta ou fechada com um bolster suturado no local ou com algum stent palatino plástico, e uma protuberância de tecido é criada no eixo de rotação (Veras Filho et al, 2010).…”