The pliancy of pedicled buccal fat pad used in reconstruction of oral submucous fibrosis-a case report

Abstract

Oral submucous fibrosis (OSF) has multifactorial aetiology which is considered to include betel quid chewing, excessive use of chillies and spices, poor nutrition and deficiency of vitamin and iron. Various treatment modalities such as nutritional supplement, intralesional steroid and placental extract injections, antioxidants, and physiotherapy have been used for conservative management of OSF. Surgical treatment includes fibrotomy (release of fibrotic bands), coronoidectomy, third molar extractions and/or reconstruction of buccal mucosa with various autografts and allografts. A 30-year old male patient reported to the Out Patient Department of Oral and Maxillofacial Surgery with the chief complaint of inability to open the mouth and difficulty in eating. Based on peculiar clinical findings, provisional diagnosis of OSF was established. Under general anesthesia, horizontal mucosal incision was placed along the occlusal plane with the surgical knife on the buccal mucosa 1cm below Stenson's duct orifice bilaterally. The fibrous bands were palpated and using fingers dissection was carried out to release fibrous bands which were followed by bilateral coronoidectomy. Pedicled buccal fat pad (BFP) was used as a graft material to cover the areas on both sides. Healing was satisfactory with no breakdown or liquefaction necrosis post operatively. Approximately 30 mm of interincisal distance was achieved and maintained postoperatively with vigorous mouth opening exercises. BFP can be used effectively as a grafting material in the surgical management of OAF with good functional and esthetic outcome.