Closure of chronic oroantral fistula: Comparison between pedicled buccal pad fat flap and free buccal pad fat graft

Background and Objective: Oroantral communication and fistula are not uncommon complications of maxillary molar extraction. The objective of this study was to evaluate the efficacy of buccal fat flaps and grafts in the closure of oroantral fistulae. Materials and Methods: This prospective comparative clinical study involved patients with chronic oroantral fistulae. In 13 patients, a pedicled buccal fat pad flap was used for closure (group 1), while a free buccal fat graft was used in 14 patients (group 2). Parameters assessed included the duration of surgery, extent of facial swelling, loss of vestibular depth, and wound breakdown and failure of closure. Results: The mean duration of surgery was 32.4 (10.5) minutes in group 1 and 29.8 (8.6) minutes in group 2. The amount of facial swelling on the second postoperative day was 2.5 (±0.6) cm in group 1 and 1.3 (±0.8) cm in group 2. At two weeks postoperatively, the reduction in vestibular depth was 5.2 (±1.7) mm in group 1 and 3.7 (±0.9) mm in group 2. Significantly greater facial swelling and reduction in vestibular depth were observed in group 1 compared to group 2 ( P = 0.00). While one case in group 1 and two cases in group 2 experienced failure with fistula reestablishment, this difference was not statistically significant ( P = 0.58). Conclusion: When employed as a free graft or pedicled flap, the buccal fat pad has demonstrated success in closing oroantral fistulas, even when dealing with large defects. This technique can be utilized either independently or in conjunction with a buccal vestibular flap to achieve a double-layer closure, enhancing the effectiveness of the procedure.