Double Layered Closure of Large Oroantral Fistula Using Bichat’s Fat Pad and Buccal Advancement Flap- A Case Report

Abstract

An oroantral fistula that develops as a complication of dental extractions, trauma due to infections (osteomyelitis), sequelae of radiation therapy, removal of maxillary pathologies (cysts or tumors) etc requires complete excision of fistulous tract and often leave large defects for surgeon to repair. Closing these defects is highly technique sensitive and requires proper method which, if not properly followed, can lead to incomplete closure. Some of the traditional methods that are employed in the repair of oroantral fistula (OAF) can be broadly classified into local and distant flaps. The choice of flap depends on the size of defect. Local flaps are used for the closure of smaller defects; however, distant flaps are employed for the closure of larger defects. Although various flaps such as buccal advancement, palatal flaps, tongue flaps are available to close the oroantral fistulae, single layer closure often leads to unfavourable outcomes that prove nuisance both for surgeon and patient. Double layer closure using combination of two flaps has proven to be successful. Recently because of versatility of buccal fat pad (BFP), it is increasingly being used in the closure of various intraoral defects secondary to trauma, resection and for repair of oroantral fistula (OAF). Since buccal fat pad (BFP) is very vascular, has its own blood supply and its close proximity to maxillary sinus makes it ideal flap for closure of oroantral communications.

This paper presents a case report on successful double layer closure of oroantral fistula (OAF) using both Buccal advancement flap (BAP) and Bichat’s Fat Pad (Buccal Fat Pad).