Synergistic Triple-layer Reconstruction of Large Oroantral Fistula: Integrating Chin Bone Graft, Buccal Fat Pad, and Buccal Advancement Flap with PRP: A Case Report

This case report outlines the successful management of a large, chronic oroantral fistula (OAF) using a three-layer closure technique in a 55-year-old male who reported nasal fluid leakage several months after maxillary molar extraction. Imaging confirmed a large communication between the oral cavity and maxillary sinus. Surgical closure was performed under general anesthesia using nasal intubation. A cortical bone graft from the chin reconstructed the bony defect, followed by the placement of a buccal fat pad (BFP) and coverage with a buccal advancement flap. Platelet-rich plasma (PRP) was applied over the graft and soft tissue layers to accelerate healing and enhance tissue regeneration. Postoperative recovery was smooth, with complete resolution of symptoms and no complications noted during follow-up. This case emphasizes the effectiveness of combining autologous bone grafting, soft tissue coverage, and PRP application in managing large chronic fistulas, providing stable outcomes and improved healing in complex clinical scenarios.