[Application of pedicled buccal fat pad/mucoperiosteal composite flap technique to prevent and seal oroantral fistula].

Abstract

Purpose: To summarize and evaluate the clinical effectiveness of the pedicled buccal fat pad combined with a mucoperiosteal composite flap in preventing and closing oroantral fistula.

Methods: This study included a total of 12 patients who underwent closure of surgical incisions following treatment of posterior maxillary lesions using a pedicled buccal fat pad combined with a mucoperiosteal composite flap. In all cases, the pedicled buccal fat pad was placed beneath the local mucoperiosteum to form a composite flap for incision closure. The retrospective analysis encompassed patients' baseline data, including age, gender, diagnosis, clinical symptoms, imaging characteristics, surgical procedures, and treatment outcomes. Additionally, the analysis included an evaluation of the local functional outcomes in the operative area.

Results: Among the 12 patients, there was an equal distribution of males and females (1∶1 ratio), with an average age of (35.83±20.17) years. Among them, 8 cases had cystic lesions in the maxillary posterior region, 3 cases had oroantral fistula, and 1 case had maxillary comminuted fracture. All patients (100%) underwent surgery involving the maxillary posterior dental region adjacent to the maxillary sinus. Preoperative symptoms included swelling, pain, halitosis, and occlusal disorder. CT imaging revealed that bone destruction in the posterior maxilla frequently affected multiple teeth, often with impacted teeth, and showed a close association with the maxillary sinus. Buccal bone resorption or destruction was the predominant feature in the operative area, and after removal of the diseased teeth, limited buccal bone remained. Wound closure was achieved using a buccal fat pad/mucoperiosteal composite flap technique. During the follow-up period, all 12 patients healed successfully, with no occurrences of oral-nasal fistula. Additionally, no significant changes in buccal morphology or vestibular groove were observed.

Conclusions: The use of a pedicled buccal fat pad combined with a mucoperiosteal composite flap is effective in sealing and preventing oroantral fistula, improving clinical symptoms in cases involving oroantral fistula and maxillary posterior bone resorption during surgery.