Comparison between pedicled buccal fat pad flap and buccal advancement flap for closure of oroantral communication

AimThe aim of this study was to evaluate efficacy of soft tissue surgical closure of Oroantral communication/ Oroantral fistula by using Buccal advancement flap & Buccal fat pad and to assess criteria for success or failure of the two surgical technique on following parameters: presence of Pain & Swelling, Infection status, Sinusitis, Fistula formation, Loss of sulcus depth. Material and methodA total of 20 healthy patients were taken irrespective of sex, caste and creed, they were between 35 and 75 years of age group. Patients were divided into two groups .Group I (n = 11 patients): Patients underwent surgical closure of OAF with buccal fat pad (BFP).Group II (n = 9 patients): Patients underwent surgical closure of OAF with buccal advancement flap (BAF). ResultsThe procedure was done successfully in all the 20 patients. 11 patients were treated with buccal fat pad and 9 were treated with buccal advancement flap. Complications were observed in 2 cases of buccal advancement flap. Both the techniques were found successful in closure of OAC. There is no statistical difference present with both the techniques while comparing parameters except the loss of buccal vestibule which was evident in case of buccal advancement flap. ConclusionWe conclude that when patient is seen with OAC, which is smaller than 3 mm should be sutured. When larger communication of more than 5 mm is seen, use of the BFP, is treatment of choice. In cases of OAF, buccal fat pad is the preferred technique over buccal advancement flap. Clinical significanceIn spite of the longer surgical time and immediate complications of the application of the buccal fat pad in closing the oroantral communications and fistula it is a good and more reliable method while comparing with buccal advancement flap. INTRODUCTION An oro-antral communication (OAC) is a pathological condition in which there is a communication between an oral cavity and the maxillary sinus as a consequence of loss of soft tissue and hard tissue which separates these structures 1 . If the OAC is maintained open to the oral cavity for more than 48 hours or if there is an infection, chronic inflammation of the sinus membrane and permanent epithelialization of the buccosinusal fistule may occur, thus increasing the risk of sinusitis. 1 OAC are usually caused by extraction of maxillary posterior teeth. The thinness of the antral floor in that region ranges from 1 to 7 mm. Although the incidence is relatively low (5%), 2,3,4 OAC are frequently encountered due to the large number of extractions. OAC may close spontaneously especially when the defect has a size smaller than 2 mm. Also, it is difficult to determine the size of the OAC clinically. To prevent PEDICLED BUCCAL FAT PAD FLAP & BUCCAL ADVANCEMENT FLAP FOR CLOSURE OF OROANTRAL COMMUNICATION: A COMPARATIVE STUDY 4(2);2018 55 Journal Of Applied Dental and Medical Sciences 4(2);2018 chronic sinusitis and the development of fistulas, it is generally accepted that all of these defects should be closed within 24 to 48 hours 2 . Currently, closure of OAC is usually performed by surgical procedure. In case of a small OAC, suturing the gingiva might be sufficient to close the perforation. When this does not provide adequate closure, a flap procedure is the treatment of choice. As Awang 4 suggested, flap procedures can be divided into local flaps and distant flaps. Local flap procedures include palatal flaps and various buccal flaps, of which Rehrmann’s and Môczáir’s techniques are widely known 5 . 1) The present study was being conducted on 20 patients with 3 months follow up, which aims at compairing efficacy of soft tissue closure of the OAC with use of buccal fat pad & buccal advancement flap. MATERIAL AND METHODS The present study was undertaken in the Department of Oral and Maxillofacial Surgery, Modern Dental College & Research Centre; Indore with due permission of the ethical committee. A total of 20 healthy patients were taken irrespective of sex, caste and creed, they were between 35 and 75 years of age group.. Patients were divided into two groups . Group I (n = 11 patients):Patients underwent surgical closure of OAF with buccal fat pad (BFP). Group II (n = 9 patients):Patients underwent surgical closure of OAF with buccal advancement flap(BAF). . Patients of both the groups were operated under local anaesthesia. The study protocol was explained to the patients in detail and their consent was obtained. All the patients were prepared preoperatively with irrigation of sinus with normal saline for 7 days or more till antral cavity was clear and no evidence of maxillary sinusitis was ensured before surgery. Inclusion criteria:i. Patients free of any systemic disease. ii. No special consideration was given to any particular socio-economic group, age and sex. iii. Patients with oro-antral communication following the extraction of the maxillary antral teeth, sinus lift procedure, while harvesting tuberosity bone graft & Oro-antral fistula were selected for the study. iv. Patient who understood the nature of the study and who were willing for regular follow up were selected. Exclusion criteria:OAC/F occurring due to the destruction of the floor of the antrum secondary to the pre existing infections or patients had the preexisting antral pathology were not selected.