Closure of oroantral communications using a pedicled buccal fat pad graft

A pedicled buccal periosteal flap for the closure of oro-antral fistula

BACKGROUND

An oroantral fistula is a communication between the maxillary antrum and oral cavity. This pathological communication is formed mainly due to dental extraction of maxillary premolars and molars. Adequate management should include closing the oroantral fistula and eliminating sinus infections to prevent recurrence and sinusitis.

PURPOSE

This study aimed to evaluate the effectiveness of using the pedicled buccal periosteal flap for closing an oroantral fistula without changing the native intraoral structure.

PATIENTS & METHODS

Patients with oroantral fistulas were included in this study. The patients were examined clinically by Valsalva test and cheek-blowing test, the hole was probed, and the extent of the underlying bone defect was determined radiographically using computed tomography preoperatively. All patients underwent surgical closure of oroantral fistula using a pedicled buccal periosteal flap.

RESULTS

All 10 patients obtained satisfactory results with marked improvement in the function of the maxillary sinus and complete healing of oroantral fistula with no recurrence except in Case No. 5, who had a recurrence of the oroantral fistula, also there was no statistically significant difference between the vestibular depth preoperatively and postoperatively.

CONCLUSION

A pedicled buccal periosteal flap is a novel technique for oroantral fistula closure as it preserves vestibular depth with a tension-free closure flap and harbors the advantages of the regenerative potential of the periosteum.

REGISTRATION DATE

14/8/2023 REGISTRATION NUMBER: NCT05987943.

Repair of Oroantral Fistulas Using Free Bone and Mucoperiosteal Flaps After Endoscopic Removal of the Medial Wall of the Maxillary Sinus

INTRODUCTION

Oroantral fistula (OAF) refers to a pathological connection between the oral cavity and maxillary sinus. It may lead to symptoms that include purulent mucus, nasal congestion, facial swelling, bad breath, and nasal regurgitation of food, all of which negatively impact patients' quality of life.

OBJECTIVE

This study presents a novel approach for OAF repair using a 2-layered structure composed of free bone and a mucoperiosteal flap obtained from the medial wall of maxillary sinus.

MATERIALS AND METHODS

Ten OAF patients who underwent repair using this method were retrospectively reviewed between August 2015 and June 2022.

RESULTS

The extraction of maxillary molars was the most common cause of OAF. The size of the fistulas ranged from 1×2 mm to 5×8 mm. Nine of the 10 patients achieved successful OAF closure following the initial operation using the 2-layer structure composed of free bone and mucoperiosteal flag. One patient was lost to follow-up. The 9 patients were observed for 6 months to 1 year, and they exhibited no obvious complications or recurrence.

CONCLUSION

The use of free bone and mucoperiosteal flag from the medial wall of maxillary sinus through an endoscope was effective for OAF repair.

Is an Attachable Oral Wound Dressing Effective at Closing an Acute Oroantral Communication?

BACKGROUND

An oroantral communication (OAC) is an acute opening after tooth extractions in the posterior maxilla that requires immediate closure. The search for a noninvasive and cost-effective OAC treatment method remains ongoing.

PURPOSE

This study assessed the effect of oral wound dressing (OWD) on acute OACs of 2-5 mm and compared it with suturing sterile gauze (SG) and plasma-rich fibrin (PRF).

STUDY DESIGN, SETTING, AND SAMPLE

A randomized, double-blind clinical trial was conducted at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Erciyes University. The sample included patients aged >18 years, a 2-5 mm wide OAC without previous maxillary sinus pathology or surgical operation.

PREDICTOR VARIABLE

The primary predictor variable was the closure method used: OWD, SG, or PRF. OWD is a new produced and commercially available product that has been used for closure of oral wounds after periodontal or surgical interventions.

MAIN OUTCOME VARIABLE

The primary outcome variable was OAC closure on postoperative day 30. The secondary outcomes were procedure duration and the pain scores of postoperative days 1, 3, and 7.

COVARIATES

The covariates were age and sex.

ANALYSES

Quantitative variables were compared between groups using the Kruskal-Wallis test. Qualitative variables were analyzed between groups using the Pearson's χ2 test. Results with a P value <.05 were considered statistically significant.

RESULTS

This study included 60 patients (30 females and 30 males). Clot formation was uneventful on postoperative days 1, 3, and 7 in all patients. OAC closure was successful in all patients on postoperative day 30. The success rate of OAC closure did not differ significantly between groups (P > .05). The surgical procedure duration was significantly shorter in the OWD group (1.2 ± 0.41 min) than in the SG (5.75 ± 0.97 min) and PRF (19.65 ± 2.74 min) groups (P < .001). Verbal analog scale scores differed significantly among the OWD (1.05 ± 1.43), SG (4.35 ± 2.85), and PRF (2.5 ± 1.82) groups on postoperative day 1 (P < .001).

CONCLUSION AND RELEVANCE

OWD is a less invasive and practical method for closing OACs.

Use of buccal fat pad-derived stem cells cultured on bioceramics for repair of critical-sized mandibular defects in healthy and osteoporotic rats

OBJECTIVE

To compare new bone formation in mandibular symphysis critical-sized bone defects (CSBDs) in healthy and osteoporotic rats filled with bioceramics (BCs) with or without buccal fat pad mesenchymal stem cells (BFPSCs).

MATERIALS AND METHODS

Thirty-two adult female Sprague-Dawley rats were randomized to two groups (n = 16 per group): group 1 healthy and group 2 osteoporotic (with bilateral ovariectomy). The central portion of the rat mandibular symphysis was used as a physiological CSBD. In each group, eight defects were filled with BC (hydroxyapatite 60% and β-tricalcium phosphate 40%) alone and eight with BFPSCs cultured on BC. The animals were sacrificed at 4 and 8 weeks, and the mandibles were processed for micro-computed tomography to analyze radiological union and bone mineral density (BMD); histological analysis of the bone union; and immunohistochemical analysis, which included immunoreactivity of vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2).

RESULTS

In both groups, CSBDs filled with BC + BFPSCs showed greater radiological bone union, BMD and histological bone union, and more VEGF and BMP-2 positivity, compared with CSBDs treated with BC alone at 4 and 8 weeks.

CONCLUSIONS

The application of BFPSCs cultured on BCs improves bone regeneration in CSBDs compared with BCs alone in healthy and osteoporotic rats.

CLINICAL RELEVANCE

Our results may aid bone regeneration of maxillofacial CSBDs of both healthy and osteoporotic patients, but further studies are necessary.

New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction

In the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique.

Management of oro-antral fistula: Two case reports and review

Oro-antral Communication is an unnatural communication between the oral cavity and maxillary sinus and when it fails to close spontaneously, it remains patent and is epithelialized so that oro-antral fistula develops. It is a common occurrence following removal of maxillary premolars and molars because of anatomic proximity of root apices of these teeth and maxillary antrum. Signs and symptoms of oro-antral fistula varies from free escape of fluids, pain, pus leakage, voice alteration, to pan-sinusitis. Several surgical options exist for its management, in particular the buccal fat pad technique, which has proved to be an effective and a reliable technique. We report in this article two-succefull cases of oro-antral fistula managed with buccal fat pad.

Closure of oroantral fistula: Comparison between buccal fat pad and buccal advancement flap: A clinical study

Background

The oro antral fistula (OAF) is an unnatural epithelialized communication between oral cavity and maxillary sinus. It may heal spontaneously but a larger fistula requires surgical intervention. OAF causes excruciating pain, escape of fluids from nose, escape of air from mouth into nose, epistaxis, change in voice due to resonance, purulent discharge in case of chronic OAF, post nasal discharge, popping out of antral polyp into oral cavity and sinusitis. Closure of OAF is strenuous, technique sensitive and challenging.

Aims and Objectives

To compare and evaluate the efficacy of buccal fat pad and buccal advancement pad for closure of oroantral fistula.

Materials and Methods

Twenty patients of age ranging from 24-64 years with complaint of OAF were included in this prospective, comparative analytic study. In group I, OAF was treated with a buccal advancement flap and in group II, BFP was sutured over the defect. All patients were called for follow up on 1^st, 7^th, 14^th and 21^st day post operatively. Pain, mouth opening, edema, infection and wound dehiscence were evaluated on each visit.

Result

The mean age of selected patients in both the treatment groups was comparable. The mean age of patients in group I was 45.00 ± 13.33 years whereas in group II the mean age was 44.00 ± 13.13 years. Pain, edema was less in Group I. Mouth opening was less in group II. We did not encountered infection and wound dehiscence in any case.

Conclusion

Various techniques can be utilized for the closure; regardless of the technique used, success of the surgical procedure depends on effective removal of fistulous tract and complete extermination of any sinus pathology and/or infection. The major factors determining the type of surgery for closure of OAF are dimension and location of the defect. The other decisive factors could be the adequacy and health of adjoining tissue. We observed buccal fat pad to be better option for closure of OAF, despite of its more morbidity; as all the complications were of some time period and when evaluated for long term.

Management of Oroantral Communications

Oroantral communication and fistula are commonly seen complications in the field of oral and maxillofacial surgery. Oral surgeons must be familiar with the diagnosis and proper management including multiple soft and hard tissue approaches to this surgical dilemma.

An Unusual Complication in Plastic Periodontal Surgery

Introduction

Oroantral communications may arise as a result of pathological processes or iatrogenic situations, particularly in oral surgery and implantology, but are uncommon in periodontal plastic surgery. Case Presentation. A healthy 37-year-old female patient with 5 mm Miller Class II recession on the maxillary left second molar was referred for a root coverage procedure. While preparing the recipient bed for the graft, an oroantral communication was created. Schneiderian membrane was sutured to reduce the dimension of the communication and covered with a connective tissue graft. Finally, the flap was laterally and coronally moved, and the patient instructed about postoperative precautions. This procedure allowed to achieve a complete closure of the oroantral communication and good root coverage after an 8-month follow-up.

Conclusions

Different authors described different techniques that can be used to close oroantral communications. Nevertheless, in this clinical case, it was shown that the oroantral communication may be closed without having to postpone the periodontal plastic surgery.

The Surgical Anatomy and the Deep Plane Thread Lift of the Buccal Fat Pad

Background

Management of facial rejuvenation by the thread lift procedure has evolved over the past few years. The role of deep plane thread lift for buccal fat pad reposition was advocated. However, there are concerns about the risks and the feasibility of the deep plane thread lift. This study was designed to determine whether the deep plane thread lift could achieve effective aesthetic results and to investigate the possible risks of critical tissue injury through cadaveric studies.

Methods

Twelve fresh frozen cephalic specimens of 8 male and 4 female Asian body donors (mean age, 63.3 ± 8.0 years) were investigated. The deep plane thread lifts for reposition of the buccal fat pads were performed for all the left hemifaces. Cadaveric dissections were performed to investigate the moving distance of the buccal fat pad and to examine the surrounding tissue of the passage of the deep plane thread lift.

Results

The average moving distance of the buccal fat pads after the deep plane thread lift was 3.73 cm. The difference in moving distance of buccal fat pads between bilateral sides was statistically significant (P < 0.001). No injuries of the critical vessels or nerves were found after cadaveric dissection. The passage of the deep plane thread lift was evaluated.

Conclusion

The deep plane thread lift for reposition of the buccal fat pad is a safe, effective, and practical method.

Use of Buccal Fat Pad in the Treatment of Peri-Implant Mucosal Defect: A Case Report

The present study describes a clinical case in which the buccal fat pad (BFP) was used to improve the contour of the peri-implant mucosa. To our knowledge, this is the first case report of such an application in the literature. A 58-year-old woman presented with teeth #2 and #3 missing and an indication for extraction of tooth #4. After clinical examination and CBCT analysis, immediate implants were placed in the region of the extracted tooth and that of tooth #2 for prosthetic rehabilitation using a three-unit fixed partial denture. There was an extensive mucosal defect in the region of tooth #3, with vertical and horizontal changes in the contour of the mucosa. As an alternative to the use of a subepithelial connective tissue graft, we opted for displacement of the BFP and its accommodation on the alveolar ridge of tooth #3 to improve the buccal tissue contour. After 5 years of follow-up, satisfactory gain and maintenance of mucosal volume were observed in the treated area, as well as improvement of buccal tissue contour. The use of BFP seems to be a feasible alternative for filling and treating peri-implant mucosal defects.

Collagen Strip Technique: A Novel Approach for Ridge Preservation and Concomitant Oroantral Communication Management After Implant Explantation

INTRODUCTION

This case report introduces a technique for managing oroantral communication (OAC) using a collagen membrane strip to repair the perforated sinus membrane and simultaneously graft the alveolar ridge.

CASE PRESENTATION

A 55-year-old Asian male presented for a second-opinion consultation regarding an endosseous dental implant that had been placed overly subcrestal at #13 edentulous site. The 8 mm fixture had been placed 3 to 4 mm subcrestally with more than half the implant length into the maxillary sinus. The patient stated that no sinus augmentation procedure had been performed. The implant was considered to be non-restorable and treatment planned for explantation with ridge preservation. Explantation revealed a sinus perforation with OAC. A collagen membrane strip (30 × 6 mm) was folded into a U-shape, to hold bone allograft for ridge preservation, and placed with the bottom of the U-shape level with the sinus floor and the ends extending to the buccal and palatal, beyond the crest. A second collagen membrane covered the graft at ridge crest level, followed by primary closure. Implant placement (4.1 × 10 mm) with indirect sinus augmentation was performed in 6 months. The implant was uncovered and subsequently restored following a 5-month osseointegration period. The 13-month follow-up examination revealed successful outcomes, with normal clinical and radiographic parameters.

CONCLUSION

This novel technique achieved the dual goals of ridge preservation and repair of a sinus membrane perforation simultaneously after implant explantation in the posterior maxilla. It further allowed a successful implant placement with simultaneous sinus augmentation and subsequent restoration.

A pedicled palatal periosteal flap for the closure of oro-antral fistula

Various surgical techniques have been developed for oro-antral fistula (OAF) closure, all of which have some drawback. Twenty consecutive patients with an OAF were enrolled in this prospective study. A trapezoid full-thickness flap extending from the palatal area to the buccal gingiva was raised, including the fistula at its centre. The palatal free end aspect was split into two layers and the deep periosteal layer was folded deep to the flap over the bony defect, thereby sealing the fistula. The superficial layer was returned to its primary position and sutured. The patients were followed for 3 months. Nineteen patients showed immediate OAF closure. One patient showed a residual oro-antral communication of 0.5mm in diameter that resolved spontaneously within 4 weeks. The pain level (on a visual analogue scale) was highest at the first follow-up week, with a mean score of 5.5, which decreased to a mean level of 2.5 in the second week and 0 in the fourth week. The mean satisfaction level was 9.85 on a scale of 0-10 (10 representing total satisfaction). The pedicled palatal periosteal flap is a simple and effective surgical technique with high predictability and patient satisfaction levels, offering one more alternative for the treatment of OAF.

An Intraoperative Salvage After Transection of the Greater Palatine Artery During Cleft Palate Repair: A Case for Buccal Fat and Buccal Myomucosal Flaps

Recently, several adjunctive procedures have gained traction to aid cleft surgeons in repairing especially challenging palatal clefts. Buccal fat flaps and buccal myomucosal flaps have demonstrated particular utility in reinforcing thin palatal flaps or tissue deficits. Although their use has not been widely accepted, they may be particularly helpful in the setting of significant scarring or vascular compromise. Here the authors describe the case of an intraoperative salvage using bilateral buccal fat flaps and a right buccal myomucosal flap after transection of the right Greater Palatine artery (GPA) during palatoplasty on a 14-month old female with Pierre Robin Sequence and a wide Veau II cleft palate. For this operative salvage, bilateral buccal fat flaps were used to reinforce the hard-soft palate junction and a 4 cm × 2 cm flap of the right-sided buccal mucosa and buccinator muscle was inset along the majority of the right-sided soft and posterior hard palate. At 2 years follow-up, the patient had no significant complications and was doing well with healthy-appearing palatal tissue and age-appropriate speech.

Versatility of the pedicled buccal fat pad flap for the management of oroantral fistula: a retrospective study of 25 cases

Purpose

Maxillary bone grafts and implantations have increased over recent years despite a lack of maxillary bone quality and quantity. The number of patients referred for oroantral fistula (OAF) due to implant or bone graft failure has increased, and in patients with an oroantral fistula, the pedicled buccal fat pad is viewed as a robust, reliable option. This study was conducted to document the usefulness of buccal fat pad grafts for oroantral fistula closure.

Materials and methods

We retrospectively studied 25 patients with OAF treated with a buccal fat pad graft from 2015 to 2018. Sex, age, OAF location, cause, duration, presence of systemic disease, smoking, previous dental surgery, and side effects were investigated.

Results

A total of 25 patients were studied. Mean patient age was 54.8 years, and the male to female ratio was 19:6. Causes of oroantral fistula were cyst enucleation, tumor resection, implant removal, bone graft failure, and extraction. Excellent results were obtained in 23 (92%) of the 25 patients. In the other two patients that both smoked, a small fistula was observed during follow-up. No recurrence of oroantral fistula was observed after 2 months to 1 year of follow-up.

Conclusions

The incidence of oroantral fistula is increasing due to implant and bone graft failures. Oroantral fistula closure using a pedicled buccal fat pad was found to have a high success rate.

Buccal Fat Pad a Forgotten Option of Reconstruction in Oral Cancer

The buccal fat pad (BFP) originally described as an anatomic structure without any obvious function. For long period it was considered to be surgical nuisance. However during the last four decades buccal fat is successively used tool for maxillofacial surgery for reconstruction of small to medium sized acquired or congenital soft tissue and bony defect in oral cavity. The aim of present article is to review the database available regarding BFP including its anatomy, clinical usage in oral malignancy as tool of reconstruction after ablative procedures it's success and its adoptability with other loco-regional flap for oral reconstruction in different scenario and our experience with it in tertiary cancer centre in India.

Repair of oroantral fistula via modified endoscopic medial maxillectomy with free nasal mucoperichondrial-osteal graft

Background: Many techniques have been proposed to close an oroantral fistula (OAF), with most of them involving transoral repairs with oral soft tissue flaps. An additional Caldwell-Luc approach or endoscopic sinus surgery (ESS) is required to address coexisting maxillary sinusitis. Objectives: This study presents the endonasal closure of an OAF through modified endoscopic medial maxillectomy (MEMM) with a free nasal mucoperichondrial-osteal graft. Materials and methods: Sixteen OAF patients who underwent closure operations in our department from May 2013 to June 2018 were retrospectively reviewed. Results: The main cause of OAF was maxillary dental cysts (56.25%). The OAF size ranged from 2 × 2 to 10 × 15 mm. The first molar (62.5%) was the most frequently involved tooth. All closures were made via MEMM, using nasal mucoperichondrial-osteal grafts harvested from the septum or nasal base. All patients were followed up for at least six months. Successful closure after a single procedure was achieved in 93.75% of cases. No obvious complications or recurrences were observed. Conclusions: Endonasal repair of OAFs via MEMM with free nasal mucosal grafts is feasible and promising. The approach preserves the normal oral and nasal physiology after surgery. It could be used alone for the closure of small to medium-sized OAFs.

Oroantral fistula after a zygomaticomaxillary complex fracture

Zygomaticomaxillary complex (ZMC) fractures account for a substantial proportion of trauma cases. The most frequent complications of maxillofacial fracture treatment are infections and soft tissue flap dehiscence. Postoperative infections nearly always resolve in response to oral antibiotics and local wound care. However, a significant infection can cause a permanent fistula. A 52-year-old man visited our clinic to treat an oroantral fistula (OAF), which was a late complication of a ZMC fracture. Postoperatively, the oral suture site dehisced, exposing the absorbable plate. However, he did not seek treatment. After 5 years, an OAF formed with a 2.0× 2.0 cm bony defect on the left maxilla. We completely excised the OAF, harvested a piece of corticocancellous bone from the iliac crest, inserted the harvested bone into the defect, and covered the soft tissue defect with a buccal mucosal transposition flap. Although it is necessary to excise OAFs, the failure rate is higher for large OAFs (> 5 mm in diameter) because of the extensive defect in the underlying bone that supports the overlying flap. Inappropriate management of postoperative wounds after a ZMC fracture can lead to disastrous outcomes, as in this case. Therefore, proper postoperative treatment and follow-up are essential.

[Clinical analysis of acellular dermal matrix and acellular bone matrix in oro-antral fistula repair]

OBJECTIVE

This study aimed to investigate the application of acellular dermal matrix and acellular bone matrix in the management of oro-antral fistula.

METHODS

Nine patients with oro-antral fistula (with defect greater than 5 mm×5 mm) after maxillary cyst resection or maxillary molar extraction were selected. The defects were repaired by the simultaneous implantation of acellular dermal matrix and acellular bone matrix.

RESULTS

The incisions of nine patients were all primary healing. After 6 months of follow-up, the oro-antral communication healed well, and no symptom such as nasal congestion or runny nose was observed. The clinical and CT examinations confirmed wound healing.

CONCLUSIONS

The usage of acellular dermal matrix and acellular bone matrix is a reliable repairing method for ora-antral fistula.

Decision-making in closure of oroantral communication and fistula

After removal of a dental implant or extraction of a tooth in the upper jaw, the closure of an oroantral fistula (OAF) or oroantral communication (OAC) can be a difficult problem confronting the dentist and surgeon working in the oral and maxillofacial region. Oroantral communication (OAC) acts as a pathological pathway for bacteria and can cause infection of the antrum, which further obstructs the healing process as it is an unnatural communication between the oral cavity and the maxillary sinus. There are different ways to perform the surgical closure of the OAC. The decision-making in closure of oroantral communication and fistula is influenced by many factors. Consequently, it requires a combination of knowledge, experience, and information gathering. Previous narrative research has focused on assessments and comparisons of various surgical techniques for the closure of OAC/OAF. Thus, the decision-making process has not yet been described comprehensively.

The present study aims to illustrate all the factors that have to be considered in the management of OACs and OAFs that determine optimal treatment.

Treatment of chronic oroantral fistula with platelet-rich fibrin clot and collagen membrane: a case report

An oroantral fistula is a complication of the maxillary posterior teeth that can occur after a tooth extraction that affects the maxillary sinus. Improper management may lead to a persistent fistula, which may become chronic. In this case report, platelet-rich fibrin (PRF) was used with a collagen membrane to close a chronic fistula in a single patient. A flap was raised, the oroantral fistula tract was eliminated, and the opening was closed with a resorbable membrane as a first layer and covered with a PRF clot as a second layer. The flap was closed, and the patient was followed up for suture removal and confirmation of complete soft tissue closure. The postsurgical sign and symptoms of the patient disappeared in the first week; complete tissue healing was detected within 2 weeks, and tissue hypertrophy was observed in the fourth week. The use of PRF may have advantages for soft-tissue healing and for accelerating soft tissue formation by subsequent hypertrophy.

Closure of Oroantral Fistula With Buccal Fat Pad Flap and Endoscopic Drainage of the Maxillary Sinus

Oroantral fistula (OAF) is a pathologic communication between the oral cavity and the maxillary sinus. It is usually associated with maxillary sinusitis, where drainage of sinus infection is a mandatory step during closure of the fistula. The flap used for closure of OAF should be tension free, broadly based and well vascularized. The aim of this study was to assess the effectiveness of closure of OAF using buccal fat pad (BFP) flap with concomitant endoscopic middle meatal antrostomy for maxillary sinus drainage. Nineteen patients with chronic OAF were included in the study. Closure was performed using BFP with endoscopic middle meatal antrostomy. Preoperative and postoperative assessments were carried out. Patients were followed up for at least 1 year postoperatively. Complete closure of all OAFs was achieved with no recurrence or dehiscence. In conclusion, closure of OAF with BFP flap and concomitant endoscopic drainage of the maxillary sinus through the middle meatus is an effective, easy, and simple method. It has a high success rate with no effect on the vestibular depth or mouth opening.

Endoscopic Repair of Persistent Oroantral Communications Using the Caldwell-Luc Approach

In this article, a novel endoscopic technique used to close oro-antral fistulas will be described. In the technique described here, 24 cases were surgically treated between May 2011, and November 2014. Under endonasal endoscopic examination following partial inferior uncinectomy, the natural ostium of the maxillary sinus was identified; through this tract, a curved aspirator was advanced into the sinus. If present, we extracted endoscopically tissues causing obliteration of the ostium through the Caldwell-Luc antrostomy, taking care to preserve the integrity of the natural ostium. In the technique described here, endoscopic examination using the Caldwell-Luc approach, the inside of the maxillary sinus is explored fully, existing infection and polyps are eliminated locally, and natural patency of the maxillary sinus ostium can be achieved. The graft used to obliterate the oroantral fistula can be easily harvested from the bone of the anterior wall of the maxillary sinus by accessing the surgical entry tract.

Reconstruction of cheek mucosal defect with a buccal fat pad flap in a squamous cell carcinoma patient: a case report and literature review

Background

Squamous cell carcinoma (SCC) is the most commonly occurring malignant tumor in the oral cavity. In South Korea, it occurs most frequently in the mandible, tongue, maxilla, buccal mucosa, other areas of the oral cavity, and lips. Radial forearm free flap (RFFF) is the most widely used reconstruction method for the buccal mucosal defect. The scar of the forearm donor, however, is highly visible and unsightly, and a secondary surgical site is needed when such technique is applied. For these reasons, buccal fat pad (BFP) flap has been commonly used for closing post-surgical excision sites since the recent decades because of its reliability, ease of harvest, and low complication rate.

Case presentation

In the case reported herein, BFP flap was used to reconstruct a cheek mucosal defect after excision. The defect was completely covered by the BFP flap, without any complications.

Conclusion

Discussed herein is the usefulness of BFP flap for the repair of the cheek mucosal defect. Also, further studies are needed to determine the possibility of using BFP flap when the defect is deep, and the maximum volume that can be harvested considering the changes in volume with age.

Reconstruction of large oroantral defects using a pedicled buccal fat pad

Background

Oroantral communicating defects, characterized by a connection between the maxillary sinus and the oral cavity, are often induced by tooth extraction, removal of cysts and benign tumors, and resection of malignant tumors. The surgical defect may develop into an oroantral fistula, with resultant patient discomfort and chronic maxillary sinusitis. Small defects may close spontaneously; however, large oroantral defects generally require reconstruction. These large defects can be reconstructed with skin grafts and vascularized free flaps with or without bone graft. However, such surgical techniques are complex and technically difficult. A buccal fat pad is an effective, reliable, and straightforward material for reconstruction.

Case presentation

This report describes three cases of reconstruction of large oroantral defects, all of which were covered by a pedicled buccal fat pad. Follow-up photography and radiologic imaging showed successful closure of the oroantral defects. Furthermore, there were no operative site complications, and no patient reported postsurgical discomfort.

Conclusion

In conclusion, the use of the pedicled buccal fat pad is a reliable, safe, and successful method for the reconstruction of large oroantral defects.

The Buccal Fat Pad for Closure of Oroantral Communication

The buccal fat pad (BFP) is a well-established tool in oral and maxillofacial surgery and its use has proved of value for the closure of oroantral communications. Oroantral communication may be a common complication after sequestrectomy in "bisphosphonate-related osteonecrosis of the jaws."The authors report a clinical case of a 70-year-old female patient in bisphosphonate therapy presented with right maxillary sinusitis and oroantral communication after implants insertion.The BFP was used to close the defect. The patient had an uneventful postoperative healing without dehiscence, infection, and necrosis.The authors postulate that the primary closure of the site with BFP may ensure a sufficient blood supply and adequate protection for an effective bone-healing response to occur.

The use of the buccal fat pad flap for oral reconstruction

Many congenital and acquired defects occur in the maxillofacial area. The buccal fat pad flap (BFP) is a simple and reliable flap for the treatment of many of these defects because of its rich blood supply and location, which is close to the location of various intraoral defects. In this article, we have reviewed BFP and the associated anatomical background, surgical techniques, and clinical applications. The surgical procedure is simple and has shown a high success rate in various clinical applications (approximately 90%), including the closure of oroantral fistula, correction of congenital defect, treatment of jaw bone necrosis, and reconstruction of tumor defects. The control of etiologic factors, size of defect, anatomical location of defect, and general condition of patient could influence the prognosis after grafting. In conclusion, BFP is a reliable flap that can be applied to various clinical situations.

Reconstruction of partial maxillectomy defect with a buccal fat pad flap and application of 4-hexylresorcinol: a case report

Mucoepidermoid carcinoma (MEC) is the most common type of malignant neoplasm in the minor salivary gland. The hard palate is a frequently involved site of MEC. The treatment of low-grade MEC on the hard palate is wide local resection with a tumor-free margin. In the present case, the maxillary defect was reconstructed using a buccal fat pad (BFP) flap, followed by application of 4-hexylresorcinol (4HR) ointment for 2 weeks. The grafted BFP successfully covered the tumor resection defect without tension and demonstrated complete re-epithelialization without any complications.

Dental implants after the use of bichat's buccal fat pad for the sealing of oro-antral communications. A case report and literature review

Oro-antral communications are frequent complications in oral surgery, and generally occur after molar extractions, maxillary sinus elevations or dental implant procedures. The presence of these defects may increase the morbidity and often need a surgical approach. The present report describes an oro-antral communication in a 52-year-old female who presented a 2 week-course of painless nasal obstruction and rhinorrea after a right maxillary sinus floor elevationwith simultaneous dental implant placement. Based on the anamnesis, clinical examination and a computed tomographyof the paranasal sinuses, a diagnosis of odontogenic rhinosinusitis associated with a 1.5 cm diameter oro-antral communicationwas establishedand its surgical closure using Bichat’s buccal fat pad was planned.After 15 months, the patient was successfully rehabilitated with an implant-supported 3 unit fixed partial denture.

Key words:Dental implants, buccal fat pad, oro-antral communications.

Use of Auricular Cartilage for Closure of Oroantral Fistula: A Prospective Clinical Study

INTRODUCTION

The term oro-antral fistula is understood to mean of fistular canal covered with epithelia which may or may not be filled with granulation tissue or polyposis of the sinus mucous membrane. With the presence of a fistula the sinus is permanently open, which enables the passage of microbial flora of the oral cavity into the maxillary sinus and the occurrence of inflammation with all possible consequences. Every now and then various researchers have proposed innumerable techniques to treat this defect. Starting from simple tissue flaps to autogenous grafts to alloplastic materials, an array of procedures have been evaluated in literature but the most promising technique still needs to be evaluated. Consequently, after reviewing an array of such procedures, our present study focussed on a new technique for the closer of oro-antral fistulas using autogenous auricular cartilage graft supported by buccal advancement flap.

MATERIAL AND METHOD

A total of 20 patients of oro-antral fistula were included in the study and after excising the fistular tract a double layer closure was done by placing auricular cartilage over the defect followed by buccal mucoperiosteal flap. The graft was harvested using posterior auricular approach. Assessment of patients was done at the end of 1 week, 3 weeks, 6 weeks, and 3 months.

CONCLUSION

We found that the autogenous auricular cartilage graft is an effective sealing material in oro-antral fistula closure. We recommend this technique for the defect size ≤10 mm² in which future dental implant placement is sought as it allows easy sinus lifting procedure.

Use of a palatal pedicle flap for closure of an oroantral fistula

Sinus lifting has become a routine procedure in modern implant dentistry. Despite its predictability, this type of surgery may eventually lead to serious complications and sequelae. Most of the time, such complications are due to technical failures, such as perforation of the sinus membrane during surgery, which may eventually lead to graft loss due to infection within the sinus, which finds its drainage path into the mouth and leads to an oroantral communication (OAC). Epithelization of such a draining duct characterizes an oroantral fistula (OAF). This report presents the use of a palatal pedicle flap to successfully close an OAF in a patient who had previously undergone a sinus lifting procedure. Several surgical techniques may be used in the closure of an OAF, and the choice of a particular technique is subject to the characteristics and location of the communication as well as to the preference of the surgeon. The palatal pedicle flap was successfully chosen in the present case report. The palatal pedicle flap was considered an adequate option for closure of an OAF in a single-stage surgical procedure, with no loss of either keratinized mucosa or buccal sulcus depth in the area of the fistula.

Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study

Background

Extensive literature exists about the use of the BFP in the treatment of oral defects but, to our knowledge, no article refers to the use of the BFP as a substitute of the membrane barriers for treatment of peri-implant bone defects. The aim was to evaluate the use of the buccal fat pad as a coating material for bone grafting in the peri-implant bone defect regeneration of immediate implants placed in the posterior maxilla.

Material and Methods

A preliminary prospective study of patients involving immediate implants in which the buccal fat pad was used as a coating material to peri-implant bone defects was carried out. The outcome measures assessed were: postoperative pain and swelling, complications related to buccal fat pad surgery, implant survival and success rates and peri-implant marginal bone loss at 12 months of prosthetic loading.

Results

Twenty-seven patients (17 women and 10 men) with a mean age of 55.3 ± 8.9 years, and a total of 43 implants were included. Two-thirds of the patients reported either no pain or only mild intensity pain and moderate inflammation, two days after surgery. Post-operative period was well tolerated by the patients and no serious complications occurred. None wound dehiscence occurred. Implant survival and success rates were 97.6% and the average marginal bone loss 1 year after loading was 0.58 ± 0.27 mm.

Conclusions

Within the limits of this preliminary study, the use of the buccal fat pad as a coating material for bone grafting in peri-implant bone defects placed in the upper posterior maxilla was a well-tolerated technique by patients; high implant success rate was achieved with a minimal peri-implant marginal bone loss at 12 months of prosthetic loading.

Key words:Buccal fat pad, immediate implant, peri-implant bone defect.

Closure of oroantral communications with Bichat´s buccal fat pad. Level of patient satisfaction

Purpose: To report the closure of oroantral communications with the pedicled buccal fat pad in a series of patients, and to determine the level of patient satisfaction after the surgery. Study Design: A prospective study of patients diagnosed of unilateral or bilateral oroantral communication (OAC) closed using the buccal fat pad between May 2012 and January 2013 was performed. Data analysis extended to: age, sex, and cause, location and size of oroantral communication. Complications and success related to buccal fat pad surgery were evaluated. Also, patient satisfaction was assessed after six months of surgery. Results: Nine patients (3 men and 6 women) with a mean age of 50.5 years and 11 OAC treated with buccal fat pads were included. The most common cause of oroantral communication was the extraction of molars. The average widest diameter of the oroantral communication was 7.1 mm. One week after the surgeries no complications were found. One month after surgery, one patient presented persistence of the oroantral communication; in this patient, the buccal fat pad technique was considered a failure, and a second intervention was performed using a buccal mucoperiosteal flap to achieve primary closure of soft tissues. After six months, patient showed closure of the communication and complete healing. All the other communications had been solved with Bichat´s ball technique, yielding a success rate of 90.9%. Mean patient overall satisfaction was 9.1 out of 10; patients were satisfied with phonetics (9.4), aesthetics (9) and chewing (9). Conclusions: The buccal fat pad technique was successful in closing 10 out of 11 oroantral communications and few complications were found. Patients were highly satisfied in overall with the treatment and with phonetics, aesthetics and chewing.

Key words:Bichat’s fat pad, buccal fat pad, oroantral communication.

Closure of oroantral fistula using titanium plate with transalveolar wiring

BACKGROUND

Alloplastic materials such as tantalum, gold plates and foils, hydroxyapatite blocks have been used for closure of oroantral fistula (OAF). However, these materials are not widely accepted in routine surgical closure of OAF due to cost, difficult handling, increased rate of infection, and exfoliation.

PURPOSE

To overcome the above drawbacks this study aimed to use titanium plates (0.3 mm) with transalveolar wiring fixation for closure of OAF.

PATIENTS AND METHODS

Ten patients with OAFs who consented to undergo this trial were selected and treated under an outpatient basis in the Oral Surgery Department, Faculty of Dentistry, Mansoura University, Egypt.

RESULTS

All OAFs were successfully treated with no eventful complications.

CONCLUSION

This study concludes that titanium plates with transalveolar wiring fixation is an excellent technique for closure of OAF. The high success rate with this technique warrants its use for closure of OAF.

Pedicled buccal fat pad flap as a reliable surgical strategy for the treatment of medication-related osteonecrosis of the jaw

PURPOSE

The purpose of this study was to evaluate the coverage of the pedicled buccal fat pad flap (PBFP) and the long-term results of this treatment in patients with medication-related osteonecrosis of the jaw (MRONJ).

PATIENTS AND METHODS

Ten patients (2 men and 8 women; average age, 72.9 yr old) diagnosed with MRONJ were selected. Patients were treated with a PBFP. Data from patients regarding MRONJ stage, defect size, bone exposure after surgery, operation time, admission period, duration of antibiotic therapy, recurrence of disease, and postoperative complications were analyzed retrospectively.

RESULTS

Six patients were diagnosed with MRONJ stage 2, and 4 patients were diagnosed with MRONJ stage 3. The maximum defect in the study was 62 × 18 mm. Among the 10 patients, there was only 1 bony exposure, which occurred on postoperative day 2 after receiving the PBFP. This exposure might have been due to an incomplete resection of the affected bone. There were no severe donor site morbidities, and all patients showed satisfactory healing without incident.

CONCLUSIONS

According to this evaluation, the PBFP effectively covered a relatively large surgical defect. Complications were minimal, and there was no recurrence of bony exposure during follow-up. In conclusion, using the PBFP was a reliable treatment option for the management of denuded bone in patients with MRONJ.

Use of the buccal fat pad in the immediate reconstruction of palatal defects related to cancer surgery with postoperative radiation therapy

PURPOSE

To evaluate the use of the buccal fat pad (BFP) in the immediate reconstruction of oncologic palate defects and the influence of postoperative radiotherapy on reconstruction.

PATIENTS AND METHODS

Patients who were diagnosed with moderate- to high-grade malignancies of the palate underwent partial maxillectomy. The BFP was used as a pedicled flap to reconstruct the defects. All patients received postoperative radiotherapy 4 to 5 weeks after surgery.

RESULTS

Eighteen patients (9 men and 9 women; age range, 37 to 81 yr) underwent surgery and subsequent radiotherapy. The size of all defects ranged from 7.5 to 19.2 cm2. Adequate closure of the defects was achieved during surgery and all flaps were epithelialized within 3 weeks after surgery, with no complications of dehiscence or flap failure. Furthermore, there were no complications derived from postoperative radiotherapy.

CONCLUSIONS

This study suggests that BFP grafting is an effective and reliable method for the reconstruction of small to medium-size palate defects. Furthermore, postoperative radiotherapy does not influence the success of reconstruction.

Evaluation of versatility and effectiveness of pedicled buccal fat pad used in the reconstruction of intra oral defects

INTRODUCTION

The use of buccal fat pad as a grafting source in the closure of intraoral defects has gained popularity in the last quarter of this century. Because of the ease of access and rich blood supply, its use in oral defects is an attractive concept.

METHODOLOGY

The study comprised of 8 patients with oral submucous fibrosis, 1 patient with oroantral fistula, 1 patient with verrucous hyperplasia. The acquired oral defects following resection of pathology in the oral cavity, were reconstructed with pedicled buccal fat pad. The Post operative follow up at the intervals of 1st, 7th and 15th day, followed by 1st month, 2nd month and 3rd month was done.

RESULTS

The procedure was successful in all the patients. Healing was satisfactory with no breakdown or liquefaction necrosis post operatively. All the patients had definitive colour change at the end of 1st post operative month owing to the epithelialisation. Residual defect was present in one patient diagnosed of verrucous hyperplasia on the 1st and the 7th post operative day which subsequently healed. In 8 patients with oral submucous fibrosis post operative mouth opening was measured in and was observed to be in the range of 12-26 mm on the 1st post operative day and 34-42 mm during 3rd month post operatively.

CONCLUSION

The results of this study support the view that the use of buccal fat pad is a simple, convenient and reliable method for the reconstruction of small to medium sized intra oral defects.

Buccal fat pad versus sandwich graft for treatment of oroantral defects: A comparison

AIM

To compare the efficacy of buccal fat pad (BFP) graft with sandwich graft (hydroxyapatite crystals embedded within collagen sheath) in closure of oroantral defects.

MATERIALS AND METHODS

A 2-year prospective study was conducted; 20 patients were included in the study were divided into two groups having 10 patients in each. Group I patients underwent surgical closure of oroantral fistula with sandwich graft and Group II patients with buccal pad of fat.

RESULTS

In Group I, the mean pain scores were 7.60 ± 0.84, 3.90 ± 1.10, 2.30 ± 1.16, 1.10 ± 0.99 and 0.40 ± 0.70 at immediate post-op., 1, 3, 6 and 12 week time intervals, respectively, whereas in Group II these were 7.30 ± 0.67, 3.50 ± 0.53, 1.70 ± 0.48, 1.00 ± 0.47 and 0.30 ± 0.48, respectively, at the corresponding time intervals. In Group I, swelling was seen to be present in 10 (100%), 7 (70%), 2 (20%) and nil (0%) patients at 1, 3, 6 and 12 weeks, respectively, whereas in Group II, it was seen to be present in 10 (100%), 10 (100%), 2 (20%) and nil (0%) patients at the corresponding time intervals. At 1 week, infection was seen to be present in 1 (10%) patient of Group I and 2 (20%) patients of Group II. At 3 and 6 weeks, infection was seen to be present in 1 (10%) patient of Group I and none of the patients of group II. No radiologic evidence of bone formation was seen in either group up to 1 week. At 3 week interval, there were 6 (60%) patients in Group I and nil (0%) in Group II showing bone formation, thus showing a statistically significant difference between the two groups. By 6 week time interval, radiologic evidence of bone formation was seen in 9 (90%) patients of Group I but in no patients of Group II, thereby showing a statistically very highly significant (P < 0.001) difference between the two groups. In Group I, in 1 (10%) patient, graft was rejected by first week; however, no further graft rejection took place. In Group II, no case of graft rejection was reported.

CONCLUSIONS

The sandwich graft technique yielded a more promising closure of oroantral communication by provision of a more biologically apt base in terms of regeneration of lost bone structure at the floor of the maxillary sinus.

Surgical options in oroantral fistula treatment

Oral fistula (OAF) is a pathological communication between the oral cavity and maxillary sinus which has its origin either from iatrogenic complications or from dental infections, osteomyelitis, radiation therapy or trauma. OAF closures can be achieved using different flaps which show both advantages and limitations. Therefore they all need careful consideration in order to select the best approach depending on the situation. The most widely employed flaps are of three types: vestibular flap, palatal flap and buccal fat pad Flap(BFP). The authors present three cases of OAF with the different techniques. It is suggested that the buccal flap is best applied in the case of large fistulas located in the anterior region, the palatal flap is suitable to correct premolar defects and the BFP flap for wide posterior OAFs.

Assessment of the Effects of Curacel and Bone Wax on the Acute Oroantral Opening Site by means of Computer Tomography and Histopathology

PURPOSE

In this study, the effects of Curacel TM oxidized regenerated cellulose and bone wax on the healing bone were compared to each other by means of CT based bone density measurement and histopathological evaluation.

METHODS

The bone density measurements of the control group were significantly higher than those of both Curacel and bone wax groups.

RESULTS

There was no significant difference between Curacel and bone wax. Histopathologically, the bone wax group showed more osteoblastic activation than Curacel group. For all measurement parameters (osteoblastic activation, osteoclastic activation, fibrous connective tissue, osseous trabeculae), Curacel and bone wax groups had worse results than control group. It is concluded that Curacel has no superiority over bone wax in terms of osseous healing in the oroantral region. There is no need to use oxidized regenerated cellulose or bone wax for small oroantral openings since the healing is better without any intervention. In addition, bone density measurement and histopathological evaluation were consistent in terms of osseous healing of the oroantral opening.