Amarjeet Gambhir
Oral submucous fibrosis is an insidious, chronic disease which may affect any part of the oral cavity and sometimes the pharynx. It is common in Asian countries, especially in India, and is strongly associated with areca nut chewing. It is characterized by blanching and stiffness of the oral mucosa in the form of fibrotic bands, which leads to progressively limited oral opening and intolerance to hot and spicy food. Many medical and surgical modalities have been tried to treat this precancerous condition. Medical therapy is beneficial only in the early stages of the disease. Surgery is the only option available for advanced stages with severe trismus and involves resection of the fibrotic bands followed by reconstruction of the defect. Various interpositional materials such as the tongue flap, nasolabial flap, palatal flap, radial forearm free-flap and split skin graft have been used with variable results for coverage of the raw intraoral defect following release of fibrosis. However, their use has been commonly limited by the associated donor site morbidity.
Over the years, the buccal fat pad has been extensively used to cover defects in the oral cavity arising secondary to a plethora of reasons. Yen first described its application for the treatment of oral submucous fibrosis. The buccal fat pad has a rich plexus of blood vessels which allows it to be used as an axial-pattern pedicled flap. The buccal extension and the main body of the fat pad are in close proximity to the buccal defect and can be approached through the same incision which was used to release the fibrotic bands. The volume of the fat pad is adequate in most of the cases and it has found to maintain its position as an interpositioning material postoperatively. The buccal fat pad by virtue of its anatomic position and excellent blood supply, ease of harvesting & mobilization, simplicity, versatility and minimal donor site morbidity seems to be a convenient and reliable interpositioning material in the surgical management of oral submucous fibrosis.
