The buccal fat pad (BFP) is a tri-lobed fatty structure surrounded by a thin fascial capsule located within the masticatory space. It is bordered medially by the buccinator muscle and laterally by the masseter muscle, ramus of the mandible and zygomatic arch. There are also four extensions that arise from the main body of the BFP, these are the buccal, temporal, pterygoid and pterygopalatine. The body and buccal extension make up the bulk (50-70%) of the fat pad and are situated more superficially, whereas the temporal, pterygoid, and pterygopalatine extensions tend to be smaller in volume and located deeper within the masticator and pterygopalatine space. The BFP has a rich vascular supply with contributions from the buccal and deep temporal branches of the maxillary artery, the transverse facial branch of the superficial temporal artery, and small branches of the facial artery. Its natural function is occupying the intermuscular area between the masseter, buccinator, temporalis and pterygoid muscles. The BFP assists muscular motion and contributes to the external morphology and shape of the face. The use of the buccal fat pad for intraoral reconstruction provides a simple, reliable and effective method for treating small to medium sized posteriorly based oral defects. We report our experience with 24 patients who underwent buccal fat pad transposition flap (BFPTF) reconstruction of 27 oral defects. Fourteen female and 10 male patients ranging in age from 22 to 81 years old were treated with the BFPTF in this study. Two patients had bilateral BFPTF. Seven (25%) of the BFPTF were used in the treatment of bisphosphonate associated osteonecrosis of the jaw, 6 (21%) in the reconstruction of postoperative squamous cell carcinoma defects, 4 (15%) for osteoradionecrosis of the mandible, 4 (15%) in the closure of oroantral fistulae following exodontia, and the remaining 6 (21%) for coverage of defects resulting from the treatment of various other pathologic conditions. The sites reconstructed using the BFPTF in the maxilla extended from the posterior maxilla and hard palate to the anterior alveolus. Other areas that were treated with the BFPTF are the retromolar trigone, buccal mucosa, and mandibular alveolus. Of the sites requiring reconstruction with the BFPTF 11 (33%) were located in the maxilla, 15 (46%) in the mandible, 3 (9%) involved the retromolar trigone, 2 (6%) were for buccal mucosal defects and 2 (6%) were for coverage of the hard palate. Three (13%) patients were smokers at the time of surgery. Four (17%) patients had undergone preoperative radiotherapy. A retrospective chart review was performed on all patients who underwent BFPTF reconstruction of various oral defects over a 3 year period from 2004 to 2007. All patients were required to have an adequate follow period >3months for inclusion in the study. Twenty four (89%) of the BFPTF healed without complication at 1 month with an overall success rate of 92.6%. There was a 4% rate of hematoma formation in the immediate postoperative period and a 7% rate of partial flap necrosis. No complete flap dehiscence was noted in the study group. The buccal fat pad transposition flap is a versatile pedicled flap for reconstruction of intraoral defects. The BFPTF is readily accessible and the technique for harvesting is simple and rapid without the addition of significant donor site morbidity. The BFPTF is ideally located for reconstruction of posterior oral cavity defects, however midline maxillary and mandibular defects can be safely approached using the BFPTF.