**8.4 Buccal pad of flat flap (BPF)**

**8.3 Palatal pedicle flap technique**

*Oral Diseases*

palate and recipient site. Advantages

1 cm in diameter [37]

excessive rotation of the flap

causes pain and discomfort

*The palatal rotation flap used to close OAC (arrow).*

healing

Limitation

**Figure 35.**

**224**

The first procedure for closing oroantral fistulas using a palatal full-thickness flap was described by Ashley [26, 32]. After excising the epithelium from its edges and cutting the palatal fibro-mucosa, the flap is created with an axial stack with a posterior base, supplied by the greater palatine artery. The palatal flap with its total thickness laterally rotated must have a large base to include the greater palatine artery at the site of its exit from the foramen (**Figure 35**) [33, 34]. The anterior extension of the flap must exceed the diameter of the bony defect and have a length sufficient to allow its lateral rotation and replacement, and the suture has no exerting tension on the vestibular mucosa [35]. Further improvement of the techniques was advocated [35, 36] by adding a flap of mucosa to the connective tissue island to cover the raw area of the palatal bone. The bone is covered, and the island flap retains excellent mobility without causing bunching of the mucosa of the hard

• Good vascularization, adequate thickness, and optimal tissue quality

demonstrated the possibility of employing this technique with wide fistulas

• This method allows replacement of the denture a short time after the wound

• It is only indicated if the fistula is located at the area of the premolar to avoid

• The area of the palatal flap will heal by secondary epithelialization, which

• Necrosis of the flap can happen if excessive rotation to the flap is performed

• The use of mucous membrane from the hard palate. In 1980, Ehrl

Since Egyedi reported the BFP flap as a suitable method to close the OAC, oronasal communication, and maxillary postsurgery defects, the technique has been widely used. In addition, according to the study by Rapidis et al. [38], the BFP can be used as a free flap to close oral defects. Tideman et al. described the detailed anatomy, vascularization, and operative techniques of BFP [39]. The pedunculated BFP has been employed for the reconstruction of an oral defect of moderate size following surgical removal of a malignant lesion [38]. A gentle dissection with fine curved artery forceps exposes the yellowish-colored buccal fat. The buccal fat pad flap, especially the pedicled type, has been used most commonly for the closure of the OAF due to the location of the buccal fat pad, which is anatomically favorable, and due to the easy and minimal dissection, with which it can be harvested and mobilized.

Advantages


#### Limitations


### **8.5 Double-layer closure techniques**

## *8.5.1 Palatal inversion flap and buccal advancement flap*

This technique designs the palatal inversion flap on the basis of the greater palatine vessels after measuring the bone defect, but not the soft-tissue defect, as shown in **Figure 35**. Once the flap is raised, the residual palatal raw surface is left to heal by secondary intension with the formation of the granulation tissue. The horizontal palatal flap is then inverted so that the oral palatal epithelial surface covers the bone defect and faces the maxillary sinus. Subsequently, it will be covered by the buccal advancement flap that is released by extending the incision inside the cheek from the gingivolabial sulcus to have a wide base and ensure a good blood supply, as shown in **Figure 34**.

Advantages


#### Limitations

• It has a risk of subsequent pathology

