**8.3 Palatal pedicle flap technique**

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 palate and recipient site.

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

*Flap Techniques in Dentoalveolar Surgery DOI: http://dx.doi.org/10.5772/intechopen.91165*

• Good rate of epithelialization [40]

• Mild reduction in the vestibular height

*8.5.1 Palatal inversion flap and buccal advancement flap*

• Low rate of failure [40]

recurrence of fistulas

**8.5 Double-layer closure techniques**

blood supply, as shown in **Figure 34**.

• It has a risk of subsequent pathology

Advantages

Limitations

**225**

oroantrual defect

mobilized.

Advantages

Limitations

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

• A second surgery is required in order to achieve closure if there is a low rate of

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

• Indicated if there is an increased risk of wound breakdown and recuurant

• It provides epithelial covering to both the superior and inferior surfaces

• Blood perfusion of the palatal flap is better than that of the single technique

Advantages


Limitation


**Figure 35.** *The palatal rotation flap used to close OAC (arrow).*
