Versatility of buccal pad fat and temporoparietal fascia flap in surgical management of oral submucous fibrosis

Abstract

The various surgical procedures for surgical management of oral submucous fibrosis (OSMF) include excision of fibrous bands with or without grafts or flaps. Materials for attempted grafting included skin, placental grafts, and artificial dermis. Materials that can be used as flaps are tongue flaps, buccal fat pad, greater palatine pedicle flaps nasolabial flaps, anterolateral thigh flap, radial forearm flap, and temporalis fascia flap. The temporoparietal flap is ultrathin surgically single layer fibrovascular sheet with high vascularity, flexibility, pliability, and versatility. Ten cases with Grade III and Grade IV OSMF with 5 patients planned for reconstruction with buccal fat pad and 5 patients planned for temporoparietal fascia flap (TPFF) after surgical resection of fibrotic bands were undertaken for the study. After 7 days, both flaps healed nicely with complete epithelization of the two flaps occurred. There were no complications except for hyperplasia of TPFF that covered the defect. Postoperative histopathological examination of hyperplastic temporoparietal fascia revealed well-differentiated squamous-cell carcinoma in one patient and in another case, there was failure of TPFF. Both buccal pad fat and TPFF are reliable for the reconstruction of buccal mucosal defects in surgical management of OSMF.