INTRODUCTION

Oro-antral communications may develop as a complication of dental extractions, but may also result from accidental or iatrogenic trauma, neoplasm or infection^1,2. Some of the traditional methods that are being employed in the repair of oro-antral communications include buccal advancement flaps, palatal rotation and palatal transposition flaps, tongue flaps, nasolabial flaps^1,3. Buccal fat pad (BFP) is increasingly being employed in the repair of oro-antral fistula (OAF) and other oral defects worldwide^4-9.

The application of buccal fat pad in the closure of oral defects is either not a common practice or under-reported in Africa. A computerized literature search using MEDLINE for articles published from 1977-2004, revealed only one report of its use from Africa¹⁰.

This article reports a case of a chronic oro-antral fistula successfully treated with the use of a pedicled buccal fat pad after several unsuccessful attempts with other local flaps. A brief literature review is presented; the advantages and possible complications of pedicled BFP are also highlighted.

CASE REPORT

A 56-year old man was referred to the outpatient clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital from a General Hospital for the management of a chronic oro-antral fistula in May 2003. The patient was reported to have had an extraction of an upper right first molar about 5 years previously and subsequently developed an oro-antral fistula (OAF). It was also reported that an attempt made to repair the fistula few months after with a local flap failed.

Examination revealed a healthy looking man with no obvious facial asymmetry. Intra-orally, oral hygiene was fair and all teeth were present except the maxillary right first molar. There was a fistula (1.8cm x 1.3 cm) at the depth of buccal sulcus in relation to the edentulous space of the missing tooth with air-bubble around the orifice. There was no discharge from the fistula or any sign of acute infection. Patient?s medical history was not significant. A clinical diagnosis of chronic oro-antral fistula was made. Periapical and occipitomental x-ray views of the sinus were taken to exclude any other antral pathologies.

The radiographs revealed a generalized thickening of right antral mucosa and a defect in the bony floor. An attempt was made to repair the fistula in our clinic under local anaesthesia with the use of buccal advancement flap after placing the patient on Amoxicillin (500mg 8hrly) and Metronidazole (200mg 8hrly) capsules for 7 days. Dehiscence of the wound was noticed 3 days after surgery and by the 7^th day, complete wound break down was noticed. Three months after, another attempt with a buccal advancement flap also failed. A decision was then made to employ the use of pedicled buccal fat pad for the repair under local anaesthesia. On the 18^th of May, 2004 a right pedicled buccal fat pad was used to repair the fistula.