Use of the Buccal Fat Pad as Free Graft for Closure of Oronasal Fistula in a Cleft Palate Patient

Abstract

Oronasal fistulas are frequent complications after cleft lip and palate surgery, with difficult treatment because of the presence of fibrotic and scarred tissue as well as the absence of local virgin tissue, representing a challenge in oral and maxillofacial surgery. The size of the fistula, its location, and the cause of the defect are important factors to determine the type of treatment and surgical technique. The use of pedicled buccal fat pad (BFP) for the repair of cleft palate has shown promising results, becoming a safe and effective method. On the other hand, the use of BFP as a free graft for oral defects has been rarely described in the literature. The current study is the first case report that shows the use of free graft of BFP in oronasal fistula after cleft lip and palate surgery and aimed to discuss the promising results of this surgical technique, suggesting it as a treatment option for anterior maxillary defects, when properly indicated.

Utilization of pedicled buccal fat pads for coverage of the lateral relaxing wound: A review of literature and a case series of 15 patients

“…In separate articles, previous studies reported a complete epithelialization period of 4–6 weeks ( 1 , 3 , 5 - 8 ). The fast healing process in this BFP graft was associated to the progression of epithelialization ( 1 , 5 , 9 ). This process possibly come from rich blood supply and fresh wound around the defect ( 1 , 8 , 9 , 12 ).…”

“…Since Indonesia - as a developing country - has a considerable amount of low economic population with poor oral hygiene maintenance, this can lead to a serious and possibly fatal complication over the result of conventional palatoplasty procedure such as infection, wound dehiscence, risk of fistula, scarring, hematoma and partial necrosis ( 5 , 9 , 10 ). Due to this fact, one of the main consideration when planning surgical procedures using BFP as pedicled graft in our cases is the excellent healing of BFP with minimal complication.…”

“…Free graft of BFP could be a right option for closure of the defect in the maxillary region, however it may be insufficient in some cases ( 9 , 13 ). In our cases, the criteria for selecting the BFP was the availability of BFP regardless of the body weight and fat distribution.…”

Clinical applications of the jugal lipectomy technique: case reports

“…However, even when a non-pedicled graft was used, as reported in the third clinical case, there was excellent tissue stability, and local vascularization was also provided by the palatal flap. Satisfactory results were also found in free grafts for treatment of patients with cleft lip and palate in the anterior region of maxilla [16] .…”

Developing a synthetic composite membrane for cleft palate repair

“…Depending on the type of surgical procedure performed, the rate of fistula occurrence has been reported to be 4.9% (Bykowski et al, ) or up to 17.7% (Kahraman et al, ). These techniques range from the use of a pedicle buccal fat pad (BFP; de Castro, de Souza, & Fernandes Santos, ), conchal cartilage graft to repair large fistula (Funayama et al, ), multilayered repair of the whole palate (Funayama et al, ), or a tri‐layered repair where the bone and cartilage are harvested from the nasal septum of the same patient and are used to create the middle layer sandwiched between two vascular layers (Hudson & Pickett, ).…”