Paul Edward Maurette

The buccal fat pad graft in the closure of oroantral communications

A male patient aged 51 years was referred for the treatment of a buccosinusal fistula of six months duration after removal of the upper left second molar. The patient complained of pain, a bad taste in the mouth and a feeling of fluid in the nose after drinking any beverage.Examination of the mouth revealed a 1 cm fistula in the bottom of the upper left sulcus, which contained pus. Computed tomographic 3D reconstruction demonstrated the bone defect and its proportion (Figure 1E, 1G).Preoperative antimicrobial therapy was started to control the infection, after which surgery was scheduled.Anesthesia involved a block of the upper posterior and middle alveolar nerves and the greater palatine nerve. An incision was made around the fistula and two other relief incisions were also made (Figure 1A). The bone defect was visualized, the necrotic tissue was removed from the bone rims and abundant irrigation was made with saline and an ampule of rifamycin (Rifocina® 75mg/1.5ml). An incision was made on the periosteum, the tissue was dissected and the buccal adipose body was rotated to the defect, covering it fully with no tension (Figure 1B). The buccal adipose body was sutured to the rim of the palatine and vestibular mucosa with 4/0 chrome catgut (Figure 1C). The mucosal flap was repositioned over the adipose tissue and similarly sutured. (Figure 1D).Postoperative medication included antimicrobials for preventing infection and the usual wound care measures.Seven days later the wound was closed, the adipose tissue was healing, and the patient reported that the symptoms were generally sub-siding. Twenty days after surgery, the mucosa was well positioned over the fully healed area and there was a slight excess fat tissue, which was removed in a second procedure.One year after surgery, computed to-mographic 3D reconstruction showed that the bone defect in the lateral wall of the maxillary sinus had regressed. (Figure 1F, 1H)