Comparison of Complications of Extraction among Partially Impacted Mandibular Third Molars with or without a Buccal Flap

Objective: To compare the complications of extraction of partially impacted mandibular third molars with or without a buccal flap. Materials And Methods: A comparative cohort study was performed at Department of Oral & Maxillofacial Surgery, Institute of Dentistry, Liaquat University Hospital, Hyderabad from September 2020 to March 2021. Sixty-two patients of either gender, having age 15-50 years and recommended for extraction of partially impacted mandibular third molars were selected by non-probability consecutive sampling technique and distributed into flapless group (31 patients) and buccal flap group (31 patients). Patients were treated with standard procedures of flapless and buccal flap, operating time was noted and follow up was done at 1st day, 2nd day post-operatively for pain, swelling, trismus, whereas periodontal pocket distal to second molar was measured at 1 month and 3 months follow up interval. Results: In flapless and buccal flap group male patients were 17 (54.8%) and 18 (58.1%) and female patients were 14 (45.2%) and 13 (41.9%) respectively with mean age of 27.4 ± 9.6 and 26.7 ± 8.4 years. Statistically significant difference was obtained in flapless and buccal flap groups in terms of operative time, pain score, swelling score, pocket depth and trismus. Conclusion: Flapless technique is more effective in conditions of operative time and post-operative complications. So, flapless technique can be used frequently for elimination of incompletely impacted mandibular third molars.

Novel Use of the Buccal Fat Pad for Sinocutaneous Fistulae Closure and a Review of Reconstructive Options

Background: Sinocutaneous fistulae (SCF) are abnormal communications between the paranasal sinuses and the overlying skin. They may be difficult to manage due to facial geometry, scar contraction, and poor tissue vascularity. We describe a novel use of the buccal flap and review the literature to examine management options for this disease process. Methods: A PubMed/MEDLINE literature search was performed for studies published between January 1, 1950 and April 29, 2020 that describe management strategies for SCF. The clinical record, imaging, and operative reports were reviewed of the case in which the buccal fat flap was used in reconstruction. Results: A total of 359 articles were retrieved. After removing duplicate articles, non-English studies, animal studies, duplicate articles and studies that mentioned SCF without specific mention of management strategies, 51 articles were reviewed. Management paradigms throughout the articles include (1) removal of infection, (2) ensuring patency of sinus outflow tracts, (3) tensionless multilayered closure using well vascularized tissue, and (4) prevention or minimization of future risk factors for fistula formation. Conclusion: This article informs surgeons on reconstructive options for sinocutaneous fistulae including a novel description of the buccal fat flap.

An MRI Case Study: The Anatomic Cleft Restoration Concept Utilizing Buccal Flaps in a Primary Palatoplasty

Purpose: Primary palatoplasties using the Anatomic Cleft Restoration Philosophy uses the buccinator myomucosal flap (buccal flap) as the major tissue replacement flap to correct the tissue deficiency within the cleft palate malformation. The surgical approach aims to close the palate without tension, lengthen the palate, reconstruct the levator muscular sling, not inhibit craniofacial growth and achieve proper resonance for speech. The purpose of this study is to present preliminary data on velopharyngeal variables to demonstrate the muscle and tissue morphology in adults with cleft palate who have not received a secondary surgery for speech or orthognathic surgery. Methods: Magnetic resonance imaging was used to analyze velopharyngeal variables for 2 individuals with the buccal flap approach and 2 individuals who received a traditional cleft palate repair. Linear measurements were obtained and 2 velopharyngeal ratios were calculated. Results: All variables were compared to previously published normative data of velopharyngeal variables for individuals with non-cleft anatomy who are of the same race, sex, and of similar age. The individuals with the buccal flap approach presented with a similar velar length and levator length in comparison to individuals with non-cleft anatomy. The individuals with the buccal flap approach presented with a longer effective velar length and velar length in comparison to individuals with a traditional cleft palate repair. Visually, the individual with the buccal flap presents with a thicker tissue mass between the hard and soft palate junction. Conclusions: In this case study, individuals who received a primary palatoplasty with the buccal flap approach presented with a longer velum and effective velar length in comparison to individuals with a traditional cleft palate repair and those with non-cleft anatomy. This study highlights the utility of using magnetic resonance imaging to quantify the changes that occur to the velopharyngeal anatomy following the buccal flap surgical approach.

Pedicled Buccal Flaps as a Back-Up Procedure for Intraoral Reconstruction

BackgroundIntraoral soft tissue deficiency and impaired wound beds are common problems after cleft and tumour surgery or after dental trauma. Frequently, limited defects are overtreated with extensive microvascular reconstruction procedures and pedicled flaps remain useful, as they are simple to harvest and provide a reliable outcome. The buccal flap, first described in the 1970s, has been used for palatine lengthening in cleft patients over decades. In the following we present an expanded indication in cases of palatal fistula, complex vestibulum, exposed bone in orthognathic surgery and osteoradionecrosis. MethodsWe conducted a retrospective chart review and report on all buccal flaps harvested within the last three years. 16 buccal flaps were performed in 10 patients. The median age at the time of surgery was 42 years, reaching from 12 years up to 66 years. Results 14 buccal flaps were used for upper jaw or palatal coverage, two buccal flaps were used in the mandible.In terms of complications (four flaps; 25 %) there were two partial flap failures, one wound dehiscence and one wound dehiscence. There were no failures of the remaining mucosal flap islands after the cut of the pedicles.ConclusionThe buccal flap is a reliable and straight forward approach to challenging intraoral wound beds with soft tissue deficiency. We thoroughly discuss the additional indications for buccal flap surgery, describe the harvest technique and provide strategies to prevent intra- and postoperative complications.

Surgical management in submucous cleft palate patients

Objectives The submucous cleft palate (SMCP) is considered to be the most subtle type of cleft palate. Early detection is important to allow on time intervention by speech therapy and/or surgical repair before the children already develop compensatory speech mechanisms. The purpose of this study was to investigate at what time children with a SMCP present, to determine when children are operated, and to analyze the postoperative outcomes for in SMCP children. Patient and methods Medical records from 766 individuals registered in the cleft registry in the Wilhelmina’s Children’s’ Hospital, Utrecht, were retrospectively reviewed. Inclusion criteria were children diagnosed with SMCP. The following data were collected: age at diagnosis, physical examination, age at surgery, surgical technique, speech therapy pre- and post-surgery, otitis media, secondary cleft surgery, family history, syndromes, and other anomalies. Results In total, 56 SMCP children were identified. The mean age of diagnosis was 44.0 months (range 0–150, SD = 37.0). In 48 children (85.7%), surgical intervention was performed (Furlow plasty, intravelar veloplasty, pharyngoplasty, or Furlow combined with buccal flap). Conclusion This retrospective study reconfirms that SMCP often presents late, even in a country with a modern healthcare system and adequate follow-up of all newborns by the so-called youth doctors in “children’s healthcare centers” up to the age of 4 years old. Almost 86% of patients ultimately needed palate surgery when SMCP was suspected. Clinical relevance Any child presenting with repeated episodes of otitis media, nasal regurgitation, or speech difficulties should have prompt consideration for SMCP as diagnosis.

Use of the Angularis Oris Axial Pattern Buccal Flap for the Correction of Facial Defects in Six Dogs

Background: Reconstructive surgery is an important area of veterinary surgery because it allows the reconstruction of large cutaneous defects in areas where a primary approach is not possible. Axial patterns flaps are composed by one direct cutaneous artery and vein, leading to a better blood supply with a good survival outcome. The angularis oris axial pattern buccal flap was introduced for correction of facial defects, but its versatility is not really explored in the existing literature. This article reports the use and complications of the angularis oris axial pattern buccal flap in six dogs, to treat defects in mandibular, temporal or labial regions.Cases: Five mixed breed dogs and one Labrador, with age between 4 and 9 years’ old were submitted for surgery and the angularis oris axial pattern buccal flap was used to close the different defects. Causes of defect included a lesion caused by myiasis in three of the dogs, and tumoral removal in the other three, where two were mast cell tumors and one a keratinizing basal cell carcinoma. The regions affected included rostral mandible with oral mucosa, intermandibular region, temporal region and upper lip. Before flap confection the tissue was cleaned, resected and prepared properly, according to each cause of lesion. The flap was made with two parallel incisions, wich center was usually the labial commissure, with the dorsal limits at the ventral aspect of the zygomatic arch, and the ventral incision on the ventral aspect of the mandibular ramus. Caudal extension was based on the length needed for surgical closure, but stained between the vertical auditory canal or up to atlas wing. Suture size and pattern depend the region and patient size. Patients were observed closely for any complication in the surgical site. From the six dogs presented here, five got some complications in the surgical site, including: lymphedema (2), suture dehiscence (4) and hematoma (1); however, regardless the complication, all patients had successful wound healing in 15 to 21 days after surgery. Also in two of the four suture dehiscence episodes, the cause of dehiscence was secondary to trauma and not the surgery.Discussion: The reconstruction of facial defects is noteworthy due the limited availability of flaps that can reach the region without excessive tension or healing complications. The angularis oris axial buccal flap pattern is the nearest flap to close defect in the intermandibular, temporal or labial regions. In the cases reported, it is possible to observe that the most frequent complication was suture dehiscence, but it occurred mostly in a small proportion of the flap, allowing healing in the expected time.The surgical planning is an important factor for reconstructive surgeries, so that there is enough tissue for the closure of the recipient and donor site, without tension over the flap or interference with tissue function and aesthetics. Despite the suture dehiscence in some of the cases, all patients showed adequate final recovery, since they returned to normal function with satisfactory cosmetic appearance.The angularis oris axial pattern buccal flap was applied in the correction of defects easily and all patients returned to normal function with satisfactory cosmetic appearance.

The Modified Caldwell-Luc Approach with the Use of Collagen Material for Treatment of a Chronic Perforated Maxillary Sinusitis

Oroantral fistula (OAF) often develops after extraction of posterior maxillary teeth and requires surgical closure. If it persists, OAF may result in maxillary sinusitis. This paper reports a case of an oroantral fistula, associated with chronic maxillary sinusitis. A 46-year-old female patient presented with a history of traumatic tooth extraction, which led to OAF formation. Three unsuccessful attempts were made to close it elsewhere. With one operation, we performed Caldwell-Luc surgery and closed OAF with a collagen membrane and plug and a buccal flap. The patient was assessed at 1-, 3-, 6-, and 12-month and 8-year follow-up visits, with no signs of maxillary sinusitis or OAF recurrence being found with the efficient amount of bone and opportunity for further dental rehabilitation like sinus lifting and dental implantation. We believe that this approach may be a viable option in similar cases.