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Figure 3Successful closure of OAF with buccal fat pad is widely reported in the literature2,7,10,12. Stajcic12 reported the use of pedicled BFP in the closure of oro-nasal and oro-antral communications following extractions in 56 patients with excellent results. Despite postoperative infection in 1 patient and partial necrosis in 2 patients, all his flaps were reported to be successful. In another report by el-Hakim and el-Fakharany10 the use of pedicled BFP was compared with palatal rotation flap in closure of antral communication and palatal defects resulting from tumor resection. They found BFP to be consistently successful, preserving the normal anatomical architecture of the oral mucosa. No denuded area requiring secondary granulation was required as in the case of palatal flaps. Pedicled BFP is also considered as a reliable back-up procedure in the event of failure of other techniques7,10. This was also confirmed by our case. Yilmaz et al2, Pandolfi et al13 and Dolanmaz et al14 also reported good results with the use of BFP in the closure of oro-antral/ oro-nasal communications.

Figure 4Pedicled buccal fat pad has also been employed in the closure of surgical defects following tumor excision7, excision of leukoplakia and submucous fibrosis15,16, as well as closure of primary and secondary palatal clefts9,17, and coverage of maxillary and mandibular bone grafts6,18. Although, no complication was observed in our case, complications in large series range between 3.1- 6.9%4,7,8,19. These included partial necrosis, infection, excessive scarring, excessive granulation and sulcus obliteration. The size of the defect in this report was 1.8cm x 1.3 cm, pedicled BFP had been successfully employed in the coverage of 7cm x 4cm x 3cm defects5. However, over-enthusiastic usage of BFP in covering very large defects should be avoided4,5.

Complete epithelization of the BFP was observed after 4 weeks of inset in our patient. This is in agreement with the established facts in the literature4,5,7. Egyedi11 recommended coverage of the exposed BFP with a skin graft, however our case confirmed other previous reports that epithelization of the flap does take place without split skin graft cover 2, 4, 5, 13 after 3-4 weeks of inset4,5,7. Histology of the healed tissue at the sites of graft have confirmed that epithelization does indeed take place, although the origin of this epithelium is not clear4,7,20. The advantages of BFP include ease of harvesting, simplicity, versatility, low rate of complications as well as quick surgical technique4,5,7,12. The operation as demonstrated in this report can also be performed with one incision, affecting neither the appearance nor function of the area. The fact that BFP is located in the same surgical field as the defects to be covered and the possibility of harvesting under local anaesthesia are added advantages.

In conclusion, pedicled buccal fat pad is a reliable flap for the repair of oro-antral fistula. The easy mobilization of the BFP and its excellent blood supply and minimal donor site morbidity makes it an ideal flap. It should also be considered as a reliable back-up procedure in the event of failure of other techniques as demonstrated by this report.