Postoperative challenges in pedicled buccal fat pad grafts: MRI evaluation and the role of bone grafting for maxillary wall regeneration

This report describes a case of postoperative complications following closure of a large oroantral fistula with a pedicled buccal fat pad (PBFP). The patient initially presented with a displaced tooth within the maxillary sinus and underwent surgical removal of a maxillary cyst with fistula closure using a PBFP. However, symptoms recurred 20 months later, and MRI revealed a bone defect and a connection between the maxillary Schneiderian membrane and buccal soft tissue, including the buccinator muscle. Bio-BMP2 grafting performed to regenerate the maxillary sinus wall during an exploratory operation resolved symptoms. The study underscores the importance of reconstructing the maxillary bone to separate buccal soft tissue from the Schneiderian membrane, particularly in cases of extensive defects.