Dentoalveolar surgery
Long-Term Effectiveness of the Pedicled Buccal Fat Pad in the Closure of a Large Oroantral Fistula

https://doi.org/10.1016/j.joms.2016.04.033Get rights and content

Purpose

This study evaluated the long-term effectiveness of the pedicled buccal fat pad (BFP) in the closure of a large oroantral fistula (OAF).

Materials and Methods

Twenty-five consecutive patients with OAFs larger than 5 mm were treated with a pedicled BFP. They were followed clinically and radiographically for 10 years after surgery to monitor the durability and effectiveness of the pedicled BFP in the closure of the OAF.

Results

The procedure was successful in all patients. The healing process was satisfactory, with no breakdown or liquefaction necrosis postoperatively. No complications were observed during the follow-up period.

Conclusions

The results of this study support the view that the use of the pedicled BFP is a durable, straightforward, convenient, and reliable method for the treatment of a large OAF.

Section snippets

Materials and Methods

Twenty-five patients (14 women and 11 men) attending the Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University (Cairo, Egypt) and needing closure of a large OAF participated in this study (Table 1). Their ages ranged from 35 to 56 years (average, 45 yr). The mean diameter of the OAF, measured clinically at the bony orifice, was 8 mm (range, 7 to 10 mm; Fig 1). Clinical and radiographic examinations of all patients showed the presence of a

Results

The patients tolerated the surgical procedures uneventfully and attended the follow-up periods regularly. Every patient received at least 10 years of follow-up, and there were no dropouts from the cohort during the follow-up period. No serious complications occurred during or after surgery. Facial edema after surgery was mild and successfully controlled with intermittent extraoral cold packs and anti-inflammatory drugs (Table 2). The healing process rapidly progressed without any major

Discussion

Several techniques have been used for the closure of large OAFs, including local or free soft tissue flaps, with or without autogenous bone grafts or alloplastic implants. The preferred technique varies from one clinician to another and depends on the case selection. For many years, use of the pedicled BFP in maxillofacial surgery has been considered a risky procedure owing to the possibility of traumatizing the pterygomaxillary space. Since Egyedi8 reported on the use of the BFP for the

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

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    In addition, cheek dimpling may become prominent. Also, cases of flap necrosis have been described32. The pedicled palatal periosteal flap technique is a simple and predictable method for the closure of OAF and overcomes the major drawbacks of the popular techniques.

  • Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus

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    Other advantages are the versatility, low rate of complications, minimal damage to the donor site morbidity, inhibiting scar formation, and quick surgical technique because it is located in the same surgical field as the cavity to be filled. In addition, the quick epithelialisation of the uncovered fat is a characteristic feature of the pedicled BFP flap and is histologically proven,16,17 therefore it can facilitate the physiological and functional recovery of the maxillary sinus. Despite lacking of a control study, our study still can indicate that filling the bone cavity with a pedicled BFP, adding iodoform gauze if needed, is sufficient for drainage, and there is no need to perform the inferior meatal antrostomy.

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Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.

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