The Combination of a Buccal Trapezoidal Flap With a Palatal Connective Pedicle Flap for the Closure of Oro-Antral Fistulae

Various surgical techniques have been developed for the closure of oro-antral fistulae (OAF), all of them presenting some limitations. Nineteen consecutive patients with a clinical diagnosis of OAF were enrolled in the present case series study. The technique being tested included the reflection of a buccal trapezoid flap with the OAF at its center. The lesion was then fully exposed and debrided. A palatal pedicle connective graft was split from the overlying mucosa and it was rotated over the lesion and under the buccal flap, thereby double-sealing the fistula. The superficial layer of the palatal flap was left at its primary position and sutured, thus ensuring primary intention healing of the palate. The patients were followed for 30 days. No patient showed residual oro-antral communication by the end of the follow-up period. The pain level was highest at the end of the first follow-up week, with a median visual analog scale of 4, which decreased to 3 in the second week, and to 0 in the fourth week. The same trend could be observed for Discomfort. The combination of a buccal flap with a split palatal connective tissue flap is an effective surgical technique with good predictability and high patient satisfaction levels.