Buccal Advancement Flap Research Articles

Closure of persistent oroantral fistula: Utilizing buccal fat pad, sticky bone, and buccal advancement flap in a three-layered approach – Case report

Oroantral communication (OAC) is a pathological connection between the oral cavity and the maxillary sinus, commonly caused by various factors such as tooth extractions and pathology. Various techniques have been employed to address oroantral fistulae (OAF), predominantly focusing on soft tissue closure and neglecting the bony defect, which is crucial for prosthetic rehabilitation. This case report highlights a novel three-layered closure technique utilizing buccal fat pad (BFP), Guided Tissue Regeneration (GTR) membrane, and a sticky bone graft composed of autogenous and xenograft with i-Platelet Rich Fibrin (PRF), combined with buccal advancement flap and collagen membrane for OAF reconstruction. This innovative approach offers promising outcomes for OAF closure, enhancing patient outcomes and minimizing postoperative complications.

Assessment of Treatment Approaches for Oroantral Communication and Fistulas

Objective: The aim of this study was to investigate and compare the treatment methods of large size oroantral defects (OADs) and their clinical outcomes. Material and Methods: The patients who referred our clinic between 2017 and 2023 suffering from oroantral fistula (OAF) and the cases which was occurred oroantral communication (OAC) larger than 5mm during oral procedures were included in the study. The size, type and cause of OAD, treatment method, the patient’s demographic data was recorded. VAS scale, analgesic requirement, the edema, and mouth opening measurements were obtained from preoperative day and postoperative records at 3, 7, 10 days after surgery. Results: 23 patient (8 OAF, 15 OAC) was included in this study. 9 of them was treated with buccal advancement flap (BAF), 10 with buccal fat pad (BFP) and 4 with press-fit technique. No problem was occurred at the healing process. Only in one patient BFP application was failed, and after 2 months second surgery was performed, and the area was fully covered. According to postoperative clinical outcomes, any statistically significance wasn’t observed between groups in the terms of vas scale, analgesic requirement, edema and trismus at any timepoint (p 0.05). Although there was insignificance at all parameters between treatment groups, VAS scale and analgesic requirement was less than BAF and BFP in press fit. Conclusion: BAF, BFP and press-fit methods are reliable and well-known techniques for OAD management, however, further clinical studies with larger sample sizes are needed to create treatment algorithm for OAD.

Oroantral Fistula Reconstruction by Pedicled Buccal Pad of Fat adjuvant with Advancement Flap (Clinical Study)

Aim: As well as highlighting the role of buccal fat of pad in closure large defects by evaluating healing process through pain, swelling and wound healing scores. Material and Method: A prospective evaluation study was conducted among patients who underwent surgical closure to OAC in both Ear Nose and Throat Department with the Maxillofacial Department of Al-Salam Teaching Hospital in Mosul City of Nineveh Province. Data recorded includes demographical Information and clinical evaluations. Two operators measured the parameters. Pain and swelling assessment through the visual analogue scale (VAS) assess the level of pain on the third, seventh and day twenty following surgery. Wound Evaluation Scale used to evaluate closure of the oroantral communication without nasal regurgitation at 1st week (day 7) and 20th days post- surgery and measure the surgical success. Results: The highest age group are between (20-29 years) with percent (56.5). male show high incidence (56.5%) more than female (43.47). In regard to cause extraction followed by tumors are the common cause for oroantral fistula (56.5%, 17.39). Day three and seven reflect different ranges of pain with highest percent for severe pain in day three (65.21%) and reduced to slight pain (82.60%) in day seven. In regard to swelling, in day three most of cases show very severe swelling (73.91%). In day seven the cases represent sever swelling (78.26%). Twenty-one patients from total 23 show incomplete healing at day seven while two patients have uncertain healing. In day 20 just one patient shows incomplete healing process. Conclusion: Buccal pad of fat can be used safely as adjuvant to buccal advancement flap for closure and is efficient in management of OAC to avoid diminished soft tissue in different size cases. Pain, swelling scales can be used as assessment for healing process added to them soft tissue wound healing scale.

The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis.

The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence. An electronic search was conducted on the MEDLINE database (Pubmed), Scopus, and Google scholar using the following keywords: "oro antral communication (OAC)" OR "oro antral fistula (OAF)" OR "antro-oral communication" OR "communication between maxillary sinus and oral cavity" OR "oro-sinusal communication" OR "oro-sinusal fistula" OR "sinus communication" OR "sinus fistula" OR "antral communication" AND "treatment" OR "management" OR "surgical treatment" OR "surgical interventions". This work was performed in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After article screening, 9 RCTs (randomized controlled trials), comparing two or more techniques, were included in this review. A statistically significant difference was detected in favor of the buccal fat pad compared to the buccal advancement flap and palatal rotational flap. With the limitations of this study, the buccal fat pad showed the best results in terms of communication closure and reducing the risk of relapse.

A case of oroantral fistula: managed successfully by buccal advancement flap

Oral epithelium migrates into the defect when an oroantral communication lasts more than three weeks, at which point it is referred to as an oroantral fistula. Oroantral fistula (OAF) can arise for a variety of reasons, including the extraction of maxillary posterior teeth, treatments for sinus augmentation, the improper use of implant drills, trauma to the craniofacial region, osteoradionecrosis, and flap necrosis. The size of the pre-existing oroantral communication affects the oroantral fistula’s treatment strategy and outcome. Instances when the oroantral communication is lesser than 2 mm in diameter it’s likely to heal and close by itself, eliminating the need for any surgical intervention. However, surgical closure is advised when the oroantral communication is higher than 3 mm or linked to periodontal or maxillary infection. In the literature, a number of algorithms have been proposed to describe the surgical methods for treating oroantral fistulas. This article aims to discuss a case of oroantral fistula of a female patient aged 34 years who presented with the chief complaint of foul discharge from the nose since 2 months.

Platelet-rich fibrin vs. buccal advancement flap for closure of oroantral communications: a prospective clinical study

ObjectivesThe primary aim was to evaluate the success of the defect closure (tight or open) of oroantral communications (OAC) after treatment with platelet-rich fibrin (PRF) clots or a buccal advancement flap (BAF). Secondary outcome measurements were the evaluation of the wound healing, the displacement of the mucogingival border (MGB), and the pain level.Material and methodsFifty eligible patients with an OAC defect larger than 3 mm were randomly assigned to either PRF (test group, n = 25) or BAF (control group, n = 25) for defect closure. In a prospective follow-up program of 21 days, the defect closure healing process, the wound healing course using Landry’s wound healing index (score: 0–5), the displacement of the MGB, and the postoperative pain score were evaluated.ResultsFive patients in each group were lost to follow-up resulting in 40 patients (20 in each group) for continuous evaluation. On postoperative day 21 (study endpoint), no difference regarding success rate (defined as closure of OAC) was noticed between the test (90%; 18/20) and control group (90%; 18/20). A univariate analysis showed significant differences for age and defect size/height for the use of PRF between successful-tight and open–failed defect healing. At the final evaluation, a significantly (p = 0.005) better wound healing score, a lower displacement of the MGB as well as lower pain-score were seen for the use of PRF.ConclusionsBased on the findings of the current study, the use of platelet-rich fibrin represents a reliable and successful method for closure of oroantral communications. The use of PRF clots for defect filling is associated with lowered pain levels and less displacement of the mucogingival border.Clinical relevanceThe defect size should be taken into account when choosing the number and size of PRF plugs.

Selecting the Best Surgical Treatment Methods in Oro-Antral Communications.

an oro-antral communication is defined as a permanent pathological connection between the maxillary sinus and the septic oral cavity. Several flaps can be used for the closure (buccal flap, palatal flap, combination techniques) but relapses occur often in case of a large defects and underlying general conditions. Bichat fad pad flap is a multipotent pedicled fatty tissue that is easily accessible from the oral cavity that can be used for the closure of medium-sized defects, even in immunocompromised patients due to its stem cell capacity. the medical information of the patients diagnosed with oro-antral communications who were admitted and treated in the Oral and Maxillo-Facial Clinic Targu Mures, between 2013 and 2020 were analyzed. A database containing general information, reported causes, associated diseases, surgical methods used during admission, and relapses, was created. The information was statistically processed. The written consent and ethical approval were obtained. the study shows that from a total of 140 cases, 72 were treated using buccal advancement flap, 49 using Bichat fat pad flap, and 19 using palatal flaps. The dimensions of the communications ranged between 0.3 cm and 1.5 cm. Several statistically significant results could be found when comparing the surgical methods. Of the 72 patients treated with buccal advancement flaps, 25 presented relapses as opposed to the patients treated with Bichat fat pad flaps who showed no complications, p < 0.05. Analysing this aspect further, all large defects (10 cases) ranging from 0.6 cm to 1.5 cm treated with advancement buccal flaps (Rehrmann flaps) showed relapses (p < 0.05). Considering the general conditions, out of 7 patients who received radiotherapy 4 presented relapses, as opposed to the healthy patients, p < 0.05. Regarding the reintervention for the relapsed cases, the majority of the cases treated a second time with buccal advancement flap (5 out of 7 cases) failed as opposed to the Bichat fat pad flap with no further relapses (p < 0.05). the most frequently used surgical treatment is the buccal flap, which also has the highest relapse rate. Both primary treatment with Bichat fat-pad flap and re-treatment of relapses using this flap have had 100% success rates, even in patients with general associated conditions, in contrast with patients treated by using the buccal flap. The dimensions of the oro-antral communication and general conditions are crucial factors for the success of the surgical treatment.

THE EFFECTIVENESS OF THE TWO-LAYERED CLOSURE OF PERSISTENT OROANTRAL FISTULA USING BUCCAL FAT PAD AND BUCCAL ADVANCEMENT FLAP.

Background: A prospective clinical study was conducted to assess the effectiveness of the two -layered closure of recurrent Oroantral Fistula using Buccal Fat Pad and Buccal Advancement Flap. Materials and methods: Twenty patients with persistent OAFs larger than 5 mm were treated with two layered closure using Buccal Fat Pad and Buccal Advancement Flap.They were followed clinically and radiographically for 5 years after surgery to monitor the durability and effectiveness of the two layered closure of the OAF. Result: The procedure was successful in all patients. The healing process was satisfactory,with no breakdown or liquefaction necrosis postoperatively.No complications were observed during the follow-up period. Conclusion: The results of this study support the view that the use of the double-layered closure using BFP with buccal advancement flap is a durable,convenient,and effective method for the treatment of a persistent large OAF.

Non‐surgical management of oro‐antral communication using platelet‐rich fibrin: A review of the literature

AbstractOro‐antral communication (OAC) is an opening between the maxillary sinus and the oral cavity, which can provide a pathway to cause an infection of the maxillary sinus. Although surgical techniques propose many advantages, several drawbacks have been reported in the previous studies. Bioactive modifiers such as platelet‐rich fibrin (PRF) are widely being used in oral surgery. Various studies have been conducted for closure of OACs using PRF. Due to the heterogeneity of the techniques found, we opted for a literature review to highlight the variety of techniques discussed in the literature. A comprehensive search of the PubMed, Google Scholar and Cochrane databases was performed for published articles between 2014 and 2021. Keywords for OAC management and repair and inclusion criteria were used to screen articles for final review. Out of 195 articles found, 12 articles were included to the study. Eight studies performed simple direct application of PRF clots, 2 studies used PRF in combination with collagen membrane and in 2 studies the treatment plan was to use buccal advancement flap reinforced by PRF. There were several variations among approaches to the closure of OAC using PRF in terms of treatment planning, pre‐ and post‐operative medication and preparation of PRF. Despite the mentioned variations, review of recent studies showed that all of the cases experienced full epithelialisation of OAC. This technique, without manipulation of any additional flaps and auto‐grafts, has several advantages. However, further research, both experimental and clinical, is necessary to unravel the success rate of using PRF in the management of OACs.

Buccal Fat Pad Reinforce Buccal Advancement Flap Vs Rotational Palatal Flap in Chronic Oroantral Fistula Treatment

Abstract Background: Oroantral fistula(OAF), the most common complication after extraction of posterior maxillary teeth leading to chronic maxillary sinusitis, patient discomfort and can cause difficulty in speech, mastication, and overall hygiene of the patient. Many treatment approaches have been developed to treat OAFs; Buccal Fat Pad (BFP) as a graft material, Buccal Advancement flap (BAF) and rotational palatal flap(RPF). Aim: To compare two treatment modalities for the management of Oroantral Fistula (OAF). We compared the clinical outcomes for both Buccal Fat Pad (BFP) reinforce Buccal Advancement flap(BAF) and rotational palatal flap (RPF) treatment approaches. Material and Methods: A total of 76 patients were included in this randomized controlled clinical study and were divided into two groups; Group A: treated with BFP reinforce BAF, and Group B: treated with RPF. Both procedures were performed under local anesthesia. All the patients were assessed clinically by Valsalva test at 1 week and 4 weeks post-surgicalwhere the surgical siteswere examined by direct visual examination for the amount of both epithelization and closure of the OAF. Results: Our results showed no statistical significant difference (P>0.05) in the clinical outcomes of for both tested OAF treatments Conclusion: Both treatment approaches are good and dependable inthe management of OAF.

Modified Inverted Periosteal Flap Versus Buccal Advancement Flap Technique for Oroantral Fistula Repair: A comparison

Oroantral fistula is a pathological and epithelised communication between pseudo stratified columnar ciliated epithelium of maxillary antrum and squamous epithelium of oral mucosa. Various techniques in literature point to the fact that repair of oroantral fistula is one of the most challenging problems in oral and maxillofacial surgery. Buccal advancement flap technique causes vestibular shortening, reduction in keratinized gingiva width with closure under tension thereby increasing the chances of wound dehiscence. On the other hand, Inverted periosteal flap preserves vestibular depth, maintains keratinized gingiva width providing true tension free closure. However, it is technically very challenging with maximum chances of perforation of delicate periosteal flap. A new Modified Inverted Periosteal Flap technique for oroantral fistula repair will eliminate all the potential complications and adverse effects of both the conventional buccal advancement flap and inverted periosteal flap procedures providing a true ideal closure.

A Novel Approach For Reconstruction Of Large Oro-antral Fistulae Defects With Simultaneous Sinus lift. (A Clinical Study)

Background: The Oro-antral fistulae (OAF) compromises the oral mucosa and the alveolar bone integrity, depleting its capacity to receive dental implants.Purpose: This clinical study aims to assess the clinical outcomes and the radiographic vertical bone gain of an innovative technique that combines the (OAF) closure, bone grafting, and sinus lift. Patients and methods: The study represents a case series conducted on thirteen patients with large (OAF), closed by sliding the buccal advancement flap combined with a distant palatal releasing incision after inverting and elevating the fistulous epithelial tract to set, elevate and conceal the floor of the maxillary sinus from the underlying bone graft. Meanwhile, evaluating the clinical outcomes and justifying a radiographic linear bone height comparison between the sinus floor height preoperatively and three months after. Results: The healing went uneventful, with neither shallowing of the vestibular depth nor obliterating the sinus cavity. The bony sinus floor was admirably elevated, and the grafted defects demonstrated appropriate bone width and height. The mean baseline bone height recorded (9.28 ±2.4 mm) versus ( 17.54 ± 1.6 mm ) for the three months postoperative. The vertical bone gain ranged from (4 to 12.5 mm), with a mean of ( 8.26 ± 2.6 mm), computing a statistically significant linear gain increase ( p < 0.00001). Conclusion: The novel approach provided comprehensive coverage of the oral defect, an appropriate primary elevation of the maxillary sinus with consolidated alveolar graft, cutting short the routine treatment time with the conduction of significant linear bone height gain values.

Comparison of two Surgical Procedures in the Management of Oroantral Fistula

Objective: To compare between double layer closure and buccal advancement flap in the management of Oro-antral fistula. Methodology: This Comparative cross sectional study was conducted on 30 patients with oral antral fistula in Maxillofacial Surgery Department, Liaquat University of Medical & Health sciences Hyderabad. The study was conducted from March 2013 to February 2019. Selection of patients was made on inclusion criteria of patient having OAF for more than 15 days, irrespective of location and side. Patients who developed Oro-antral fistula (OAF) because of any pathology or its treatment, and patient having bleeding tendency were excluded. Division of two groups to avoid any bias in this study was done by using random number table. Group-I was treated with buccal advancement flap while group-II with “double layer closure “with buccal fat pad” and 2nd layer with buccal advancement. The outcome was evaluated for any postoperative complications like wound dehiscence, necrosis, infection. Results: Males and females were 67% and 33% respectively. The mean age was 35.03±9.56 years. Maxillary molars were the common site for OAF. Maxillary first molar followed by second molar site was ranked according to frequency of this condition. Buccal advancement procedure was used in group A and in this cluster 86.6% cases were successful. In Group B, a double layered closure procedure was used and the success rate was 93.3% which is statistically not significant. Conclusion: Double-layered closure using BFP with buccal advancement flap should be kept as a valuable option in mind in the management of OAF. Key Words: Buccal Advancement Flap, Oro-Antral Fistula, Buccal Fat Pad, Double Layered Closed Technique.

THE OROANTRAL FISTULA: A CASE REPORT

Introduction: An unnatural communication between the maxillary sinus and oral cavity is known as “oroantral communication”(OAC) and if it does not close spontaneously, it is epithelialized so that oroantral fistula develops.(2) The most common cause of oroantral fistula is the extraction of a maxillary molar or premolar.(2,11) The close relationship between the apex of these teeth and the thinness of the antral floor explains this.(11) From simple local methods like buccal advancement flap to complex distal flaps and grafts, various methods have been described in the literature for the closure of these communication.(2) To facilitate gravitational drainage and aeration via an inferior meatal antrostomy and to remove irreversibly damaged mucosa of the maxillary sinus, Caldwell Luc procedure was designed.(10) Objective: To describe a case report of oroantral fistula [OAF] and its closure. Case Report: We repot a case of 28 years old male patient who came to our attention for the presence of the OAF and presence of maxillary third molar root piece in the maxillary sinus. This patient was treated by“ OBTURATOR procedure.”

Closure of oroantral fistula: Comparison between buccal fat pad and buccal advancement flap: A clinical study.

Background:The oro antral fistula (OAF) is an unnatural epithelialized communication between oral cavity and maxillary sinus. It may heal spontaneously but a larger fistula requires surgical intervention. OAF causes excruciating pain, escape of fluids from nose, escape of air from mouth into nose, epistaxis, change in voice due to resonance, purulent discharge in case of chronic OAF, post nasal discharge, popping out of antral polyp into oral cavity and sinusitis. Closure of OAF is strenuous, technique sensitive and challenging.Aims and Objectives:To compare and evaluate the efficacy of buccal fat pad and buccal advancement pad for closure of oroantral fistula.Materials and Methods:Twenty patients of age ranging from 24–64 years with complaint of OAF were included in this prospective, comparative analytic study. In group I, OAF was treated with a buccal advancement flap and in group II, BFP was sutured over the defect. All patients were called for follow up on 1st, 7th, 14th and 21st day post operatively. Pain, mouth opening, edema, infection and wound dehiscence were evaluated on each visit.Result:The mean age of selected patients in both the treatment groups was comparable. The mean age of patients in group I was 45.00 ± 13.33 years whereas in group II the mean age was 44.00 ± 13.13 years. Pain, edema was less in Group I. Mouth opening was less in group II. We did not encountered infection and wound dehiscence in any case.Conclusion:Various techniques can be utilized for the closure; regardless of the technique used, success of the surgical procedure depends on effective removal of fistulous tract and complete extermination of any sinus pathology and/or infection. The major factors determining the type of surgery for closure of OAF are dimension and location of the defect. The other decisive factors could be the adequacy and health of adjoining tissue. We observed buccal fat pad to be better option for closure of OAF, despite of its more morbidity; as all the complications were of some time period and when evaluated for long term.

Comparing the efficacy of Platelet-Rich Fibrin (PRF) with the Buccal Advancement Flap for the Closure of Acute Oroantral Communication

The pathological communication between maxillary sinus and oral cavity is known as the Oro-Antral Communication...

Management of Oroantral Communication Using Double Layered Closure with Buccal Fat Pad and Buccal Advancement Flap: Prospective Randomized Clinical Study

Introduction: Although many techniques are available for management of oroantral communication, they&#x0D; utilize single layer tissue for closure of defect which is composite in nature. There is limited evidence in&#x0D; literature regarding efficacy of double layered closure using combination of flaps. This study was designed&#x0D; to assess utility of double layer closure of oroantral communication using buccal fat pad and buccal mucosa&#x0D; advancement flap.&#x0D; Material and Method: Patients with oroantral communication were randomly allocated to two groups;&#x0D; group A were treated with two layered closure (buccal fat pad and buccal mucosa) and group B were treated&#x0D; with single layer closure (buccal fat pad). Same protocol of perioperative management was used for both&#x0D; groups. The postoperative parameters evaluated included success of surgery (complete closure without any&#x0D; nasal regurgitation), duration of surgery, pain, swelling and mouth opening.&#x0D; Results: Total of 27 patients were divided into group A (n=13) and group B (n=14). The mean size of the&#x0D; defect was 28.23 mm in study group and 24.57 mm in the control group. The surgical procedure took more&#x0D; time (42.23 minutes) in group A, as compared to group B (26.21 minutes). Post-operative evaluation of pain&#x0D; and mouth opening showed no statistically significant between the two groups at 7th and 30th postoperative&#x0D; days respectively. However, swelling was relatively more when combination of buccal fat pad and buccal&#x0D; advancement flap was used.&#x0D; Conclusion: Double layered closure is efficient in management of OAC. No dehiscence of flap was seen in&#x0D; study group. Comparatively 3 dehiscence was observed in control group, especially with large size defect.&#x0D; The postoperative sequel in both groups was similar.

Clinical and Radiographic Assessment of cyanoacrylates Opposing Buccal sliding flap for the immediate repair of Oroantral communication

Introduction: Oroantral communication is an uncommon, inadvertent incident resulting from various causes the most commonof which is the extraction of upper molars. Immediate closure of the communication is highly recommended to avoid infectionand subsequent fistulous tract formation. Cyanoacrylate tissue glue was introduced as a reliable method for flapless sealing of thecommunication without any of the complications associated with the surgical maneuvers. One of the oldest surgical proceduresused for closure of the Oroantral communication is the buccal advancement flap which proved efficiency in complete closureof the defect with minimal related complications.Aim of the study: The study aims evaluate the immediate flapless closure of Oroantral communication using cyanoacrylatesversus the buccal sliding advancement flap.Patients and Methods: Twenty patients suffering from instant oroantral communication were included in the study. CBCTwas performed to each of them to confirm the diagnosis, patients were divided into two groups where Group I (Study group)patients were treated by sealing of the defect using periacry l90 HV while Group II (control group) patients performed Buccalsliding advancement flap. Clinical follow up including pain, facial swelling, recurrence of the defect and sulcular depth up wereperformed at day 1, 3, 7, 15 and 1 month. CBCTs were done at 3 and 6 months postoperative to assess healing of the defectregarding size and density.Results: Clinically Group I showed minimal pain and swelling with no change of sulcular depth. In contrast, Group II showedhigh pain level and increase in facial swelling together with a significant decrease in sulcular depth. None of the patients inboth groups showed any recurrence of the condition. CBCTs showed decrease in defect size and formation of bone within thedefect in both groups.Conclusion: Both maneuvers are good modalities for treating OAC, however cyanoacrylate is associated with minimalcomplications.

USE OF BUCCAL ADVANCEMENT FLAP FOR REPAIR OF OROANTRAL FISTULA: A CASE SERIES STUDY

Objective: To evaluate the success rate of Buccal advancement Flap (BAF) in closure of Oroantral communication (OAC) and Fistula. Materials and Methods: In this case-series study, buccal advancement flap (BAF) was used in 45 consecutive patients at Oral and Maxillofacial Surgery Department of Fatima Memorial Hospital Lahore for period of one year (May 2018-May2019). Male to female ratio was 2:1 and mean age=26 years. Right maxillary OAF of first and second molars presented more than left side (n=35, 77%). All defects were not more than 5mm. After application of flap, patients were evaluated for sign and symptoms of infection, wound dehiscence, loss of flap whether partial or complete and recurrence of oroantral fistula (OAF). Data was analyzed using SPSS version 20, INC, Chicago USA with descriptive analysis to derive percentages and frequencies for all variables. Results: Thirty nine patients (86%) had successful healing of flap. Partial loss occurred in one patient (2.25%). Wound dehiscence was seen in two patients (4.45%). Complete loss of flap was also noted in two patients (4.45%). Recurrent OAF has occurred in one patient (2.25%). Conclusion: BAF is a flap of choice for immediate closure of OAC and OAF of ≤5mm in the region of maxillary first and second molar. The technique is simple and vascular supply ensures the proper healing of flap. More work needs to be done to evaluate the causes for the partial or complete loss of the flap.

Rose-trellis periosteal release in oral mucosal advancement flaps in pigs.

The aims of this study were to find out whether scoring in a rose-trellis pattern improved the stretch of mucoperiosteal flaps more than conventional scoring in the horizontal plane, and to consider its application in the closure of oroantral communications. Sixteen sections of cadaveric porcine buccal mucoperiosteum were removed from the molar region of the maxilla and mandible. A three-sided flap was raised in the subperiosteal plane, excised, and pinned to a cork board with the periosteal side facing upwards. Eight samples were scored in the horizontal plane (control) using lines perpendicular to the line of simulated advancement, and eight in a rose-trellis or criss-cross pattern. Scoring using a rose-trellis pattern yielded a mean increase in stretch of 24.3% (p=0.0003) when compared with the conventional method. Buccal advancement flaps are widely used to close oroantral communications, and scoring of the mucoperiosteum facilitates the stretching of the tissue over the defect. To be successful, defects should be fully closed to prevent contamination, and closure should be tension-free. In this study, scoring in a rose-trellis pattern increased the stretch of the tissue sample more than scoring in the horizontal plane. The rose-trellis technique therefore could aid the effective closure of oroantral communications.