SURGICAL CLOSURE OF LARGE OROANTRAL FISTULA BY MODIFIED SANDWICH TECHNIQUE AND PEDICLED BUCCAL FAT PAD : (A CLINICAL STUDY)

Aim: The aim of this study was to evaluate the efficacy of modified sandwich technique and pedicled buccal fat pad (PBFP) to achieve both hard and soft tissue closure of large OAF.
Patients and methods: The bony defects of five patients complaining from large OAF were grafted by modified sandwich technique comprising Fisiograft bone substitute between absorbable haemostat membrane (surgicel) and guided tissue regeneration membrane. Then the sandwich graft was covered by buccal bad fat graft. The patients were followed up clinically after 1, 2, 4 and 12 weeks postoperatively. Radiographic evaluation by OPG and nuclear bone scan was performed immediately, 3, and 6 month postoperatively.
Results: Successful closure of the OAF was achieved in all cases without reported recurrence of the OAF or regurgitation of fluids from the nose. Radiographically, after 3rd month, bony defects of the OAF showed partial radioopecity which completed at 6th month interval. Bone scan measurements showed highly statistically significant increase in the bone activity values at grafted site after 3rd month postoperatively. While activity index (AI) values at 6 month interval decreased to return toward lower level than baseline values.
Conclusion: The results clearly concluded that this technique with PBFP is successful in achieving proper anatomical closure of large OAF in terms of both hard and soft tissues.