Combined Use of Buccal Fat Pad and Buccal Advancement Flap for Large Oroantral Fistula Closure: A Case Report

Oroantral communication (OAC) is a pathological communication between the oral cavity and the maxillary sinus, most commonly resulting from posterior maxillary tooth extraction. If left untreated, OAC can progress to oroantral fistula (OAF) and may require surgical intervention. This case report presents the diagnosis and treatment of chronic OAF in a 50-year-old male patient with systemic comorbidities such as diabetes and hypertension and a smoking habit. Clinical and radiographic examination confirmed a persistent oroantral defect associated with chronic sinusitis five years after extraction. Surgical closure was performed using a combined approach involving buccal fat pad (BFP) and a buccal advancement flap. With its rich vascular supply, anatomic proximity, and low complication rate, BFP provided an effective solution for large oroantral defects. Postoperative recovery was uneventful, and follow-up showed successful closure and mucosal regeneration. This case highlights the effectiveness of the double-layer surgical technique in managing large, chronic OAFs, especially in patients with complicating systemic factors.