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Procedure: The patient was placed on Amoxicillin capsules (500mg 8hrly) three days before the surgery. Excision of the fistulous tract from the sinus to the oral cavity and freshening of the wound edges done after local anaesthesia with 2% lignocaine with adrenaline 1: 80,000 was achieved (Figure 1).Figure 1

A right upper vestibular horizontal incision, posterior to the second molar was made and this was extended the posterior margin of the fistula to expose the BFP. Careful manipulation and blunt dissection was done to fully mobilize and advance the flap to the recipient site (Figure 2).

The flap was sutured in place with simple interrupted 3/0 black silk sutures (Figure 3).

The incision was also closed over the bridge segment of the flap with 3/0 black silk sutures.

Patient was warned against blowing the nose for 2 weeks. Pre-operative antibiotic was continued for the next 7 days. Patient was reviewed at regular one week intervals and sutures were removed 2 weeks after the procedure. At the end of the 4th week, full epithelization of the flap had taken place (Figure 4). No postoperative complication was observed.

 

Figure 2DISCUSSION

The buccal fat pad is an encapsulated, rounded, biconvex specialized fatty tissue which is distinct from subcutaneous fat. It is located between the buccinator muscle medially, the anterior margin of the masseter muscle and the mandibular ramus and zygomatic arch laterally4,6.Buccal fat pad (BFP) was considered a surgical nuisance for many years because of its accidental encounter during various operations in the pterygomandibular area such as tumor, orthognathic, or trauma surgeries4,5. Egyedi 11 in 1977 first reported the use of pedicled BFP for closure of post-surgical maxillary defects. Since then, BFP has become a popular option among surgeons worldwide for the reconstruction of small to medium acquired or congenital soft tissue and bone defects in the oral cavity 4-8. However, the procedure is not commonly practiced in Sub-Saharan Africa as revealed by our literature search. This may be due to lack of awareness of the usefulness of BFP for oral reconstruction among surgeons in this part of the world.