Use of Buccal Fat Pad Flap in Treatment of Bisphosphonate-related osteonecrosis of the jaws (BRONJ): Literature Review and Report of 15 Cases

Purpose: Oral defects are common following surgical treatment of many pathological conditions of the oral cavity. The buccal fat pad flap (BFP) provides a convenient and reliable method for treating small to medium sized defects. However there are only a few studies in the literature reporting its use in management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and osteoradionecrosis (ORN). The purpose of this study is to review literature, evaluate outcome, success rate and complications in patients treated with buccal fat pad flap as primary soft tissue coverage in surgical management of intraoral defects related to BRONJ and ORN.

Patients and Methods:A retrospective chart review of patients treated with buccal fat pad flap for various intraoral defects created secondarily from the treatment of BRONJ, ORN, osteomyelitis, malignancies, oro-antral fistulas from year 2009 to 2013 by the senior author was conducted. Fifteen patients were included in the study out of which 5 patients had BRONJ. Patients without adequate follow up were excluded from the study. In these patients 10 defects were in mandible and 5 defects in the maxilla. Mean follow up is 12.5 months (1 month to 24 months). 

Results:The buccal fat pad flap healed without complication in 11 patients, 2 patients had minor complications and one patient had flap failure. No flap failure was noted in BRONJ/ ORN patients. Overall success rate was 93.33%.

Conclusion: The buccal fat pad flap is a reliable pedicled soft tissue flap for reconstruction of BRONJ/ ORN defects in both maxilla and mandible and should be considered as first line therapy for patients with symptomatic bone exposure requiring debridement and reconstruction.

References

Gallego, L. (2012). The use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related osteonecrosis of the maxilla. Medicina Oral, Patología Oral y Cirugía Bucal, 17(2), e236.

Tideman, H. (1986). Use of the buccal fat pad as a pedicled graft. Journal of Oral and Maxillofacial Surgery, 44(6), 435. doi: 10.1016/S0278-2391(86)80007-6