Skip to main content

Advertisement

SpringerLink
Log in

Comparative evaluation of nasolabial flap and buccal fat pad flap in the surgical management of oral submucous fibrosis: a systematic review and meta-analysis

  • Review Article
  • Published:
Oral and Maxillofacial Surgery Aims and scope Submit manuscript

Abstract

Purpose

Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition affecting any part of the oral cavity and is prevalent in Southeast Asia and the Indian subcontinent. The aim of this study is to compare the efficacy of buccal fat pad flap with the nasolabial flap in the management of OSMF.

Methods

We systematically compared two commonly used constructive techniques in the management of OSMF: the buccal pad of fat flap and the nasolabial flap. We performed a comprehensive search in four databases for all articles published between 1982 and November 2021. We assessed the risk of bias using the Cochrane Handbook and Newcastle–Ottawa Scale. We used the mean difference (MD) for pooling the data with 95% confidence intervals (CIs) and evaluated the heterogeneity between pooled studies using χ2 and I2 tests.

Results

Out of 917 studies, six were included in this review. The meta-analysis significantly favored conventional nasolabial flap over buccal fat pad flap in improving the maximal mouth opening (MD, − 2.52; 95% CI, − 4.44 to − 0.60; P = 0.01; I2 = 0%) after OSMF reconstructive surgery. Conversely, when it comes to esthetic outcomes, these studies favored buccal fat pad flap.

Conclusion

Our meta-analysis found that nasolabial flap was better than buccal fat pad flap in terms of mouth opening restoration after OSMF reconstructive surgery. Also, the included studies found better results, favoring nasolabial flap over buccal fat pad flap in terms of oral commissural width restoration. Also, these studies reported better outcomes in terms of esthetics, favoring buccal fat pad flap. Further studies with larger sample sizes and different populations/races are needed to confirm our findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

The data supporting the findings of this study are available on request from authors.

References

  1. Angadi PV, Rekha K (2011) Oral submucous fibrosis: a clinicopathologic review of 205 cases in Indians. Oral Maxillofac Surg 15(1):15–19

    Article  PubMed  Google Scholar 

  2. Jayanthi V, Probert C, Sher K, Mayberry J (1992) Oral submucosal fibrosis–a preventable disease. Gut 33(1):4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ghom AG, Ghom SAL (2020) Textbook of oral medicine. JP Medical Ltd.

  4. Prabhu RV, Prabhu V, Chatra L, Shenai P, Suvarna N, Dandekeri S (2014) Areca nut and its role in oral submucous fibrosis. J Clin Experimental Dent 6(5):e569

    Article  Google Scholar 

  5. Mehrotra D, Pradhan R, Gupta S (2009) Retrospective comparison of surgical treatment modalities in 100 patients with oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 107(3):e1–e10

    Article  Google Scholar 

  6. Sikkerimath B, Dandagi S, Anshu A, Jose A (2021) Comparative evaluation of reconstructive methods in oral submucous fibrosis. J Maxillofac Oral Surg 20:597–606. https://doi.org/10.1007/s12663-020-01493-x1-10

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Aziz S (1997) Oral submucous fibrosis: an unusual disease. J New Jersey Dent Asso 68(2):17–19

    CAS  Google Scholar 

  8. Murti P, Bhonsle R, Pindborg J, Daftary D, Gupta P, Mehta FS (1985) Malignant transformation rate in oral submucous fibrosis over a 17-year period. Community Dent Oral Epidemiol 13(6):340–341

    Article  CAS  PubMed  Google Scholar 

  9. Kamath VV (2015) Surgical interventions in oral submucous fibrosis: a systematic analysis of the literature. J Maxillofac Oral Surg 14(3):521–531

    Article  PubMed  Google Scholar 

  10. Khanna J, Andrade N (1995) Oral submucous fibrosis: a new concept in surgical management: report of 100 cases. Int J Oral Maxillofac Surg 24(6):433–439

    Article  CAS  PubMed  Google Scholar 

  11. Agrawal D, Pathak R, Newaskar V, Idrees F, Waskle R (2018) A comparative clinical evaluation of the buccal fat pad and extended nasolabial flap in the reconstruction of the surgical defect in oral submucous fibrosis patients. J Oral Maxillofacial Surg 76(3):676. e671-676. e675

    Article  Google Scholar 

  12. Anehosur V, Singh PK, Dikhit PS, Vadera H (2020) Clinical evaluation of buccal fat pad and nasolabial flap for oral submucous fibrosis intraoral defects. Craniomaxillofac Trauma Recon 14(3):196–200

    Article  Google Scholar 

  13. Saravanan K, Narayanan V (2012) The use of buccal fat pad in the treatment of oral submucous fibrosis: a newer method. Int J Dent 2012:935135. https://doi.org/10.1155/2012/935135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Patil SB, Durairaj D, Kumar GS, Karthikeyan D, Pradeep D (2017) Comparison of extended nasolabial flap versus buccal fat pad graft in the surgical management of oral submucous fibrosis: a prospective pilot study. J Maxillofacial Oral Surg 16(3):312–321

    Article  Google Scholar 

  15. Wells GA, Shea B, O’Connell D, et al (2000) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Oxford.

  16. Higgins JPT, Altman DG, Gøtzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rai A, Datarkar A, Rai M (2014) Is buccal fat pad a better option than nasolabial flap for reconstruction of intraoral defects after surgical release of fibrous bands in patients with oral submucous fibrosis? A pilot study: a protocol for the management of oral submucous fibrosis. J Cranio-Maxillofac Surg 42(5):e111–e116

    Article  Google Scholar 

  18. Gupta PC, Mehta FS, Daftary D et al (1980) Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. Community Dent Oral Epidemiol 8(6):283–333

    Article  CAS  PubMed  Google Scholar 

  19. Pundir S, Saxena S, Aggarwal P (2010) Oral submucous fibrosis a disease with malignant potential: report of two Cases. J Clin Experim Dent 2(4):215–218

    Article  Google Scholar 

  20. Tiwari P, Bera RN, Chauhan N (2020) What is the optimal reconstructive option for oral submucous fibrosis? A systematic review and meta-analysis of buccal pad of fat versus conventional nasolabial and extended nasolabial flap versus platysma myocutaneous flap. J Maxillofac Oral Surg 19:490–497

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yeh C-J (1996) Application of the buccal fat pad to the surgical treatment of oral submucous fibrosis. Int J Oral Maxillofac Surg 25(2):130–133

    Article  CAS  PubMed  Google Scholar 

  22. Sharma R, Thapliyal G, Sinha R, Menon PS (2012) Use of buccal fat pad for treatment of oral submucous fibrosis. J Oral Maxillofac Surg 70(1):228–232

    Article  PubMed  Google Scholar 

  23. Kavarana N, Bhathena H (1987) Surgery for severe trismus in submucous fibrosis. Br J Plas Surg 40(4):407–409

    Article  CAS  Google Scholar 

  24. Borle R, Borle S (1991) Management of oral submucous fibrosis: a conservative approach. J Oral Maxillofac Surg 49(8):788–791

    Article  CAS  PubMed  Google Scholar 

  25. Baumann A, Ewers R (2000) Application of the buccal fat pad in oral reconstruction. J Oral Maxillofac Surg 58(4):389–392

    Article  CAS  PubMed  Google Scholar 

  26. Egyedi P (1977) Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications. J Maxillofac Surg 5:241–244

    Article  CAS  PubMed  Google Scholar 

  27. Yen DJ (1982) Surgical treatment of submucous fibrosis. Oral Surg Oral Med Oral pathol 54(3):269–272

    Article  CAS  PubMed  Google Scholar 

  28. Dubin B, Jackson IT, Halim A, Triplett W, Ferreira M (1989) Anatomy of the buccal fat pad and its clinical significance. Plas Recon Surg 83(2):257–264

    Article  CAS  Google Scholar 

  29. Paissat DK (1981) Oral submucous fibrosis. Int J Oral Surg 10(5):307–312

    Article  CAS  PubMed  Google Scholar 

  30. Hynes B, Boyd JB (1988) The nasolabial flap: axial or random? Arch Otolaryngol Head Neck Surg 114(12):1389–1391

    Article  CAS  PubMed  Google Scholar 

  31. Garatea J, Buenechea R, Bescos C, Gonzalez E, Bassas C (1991) Intraoral reconstruction with the nasolabial island flap: a modified technique. J Cranio-Maxillofac Surg 19(3):119–122

    Article  CAS  Google Scholar 

  32. Borle R, Nimonkar P, Rajan R (2009) Extended nasolabial flaps in the management of oral submucous fibrosis. Br J Oral Maxillofac Surg 47(5):382–385

    Article  CAS  PubMed  Google Scholar 

  33. Braasch DC, Lam D, Oh ES (2014) Maxillofacial reconstruction with nasolabial and facial artery musculomucosal flaps. Oral Maxillofac Surg Clin 26(3):327–333

    Article  Google Scholar 

  34. Bande CR, Datarkar A, Khare N (2013) Extended nasolabial flap compared with the platysma myocutaneous muscle flap for reconstruction of intraoral defects after release of oral submucous fibrosis: a comparative study. Br J Oral Maxillofac Surg 51(1):37–40

    Article  PubMed  Google Scholar 

  35. Mokal N, Raje R, Ranade S, Prasad JR (2005) Thatte R. Release of oral submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft—a new technique. Brit J Plastic Surg 58(8):1055–1060

    Article  CAS  Google Scholar 

  36. Wei F-C, Chang Y-M, Kildal M, Tsang W-S, Chen H-C (2001) Bilateral small radial forearm flaps for the reconstruction of buccal mucosa after surgical release of submucosal fibrosis: a new, reliable approach. Plastic Rec Surg 107(7):1679–1683

    Article  CAS  Google Scholar 

  37. Ambereen A, Lal B, Agarwal B, Yadav R, Roychoudhury A (2019) Sandwich technique for the surgical management of oral submucous fibrosis. Br J Oral and Maxillofac Surg 57(9):944–945

    Article  Google Scholar 

  38. Bakamjian VY (1965) A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstructive Surg 36(2):173–184

    Article  CAS  Google Scholar 

  39. Wei Fu-Chan MD, Chang Yang-Ming DS, Kildal Morten MD, Tsang Wen-Sun MD, Chen Hung-Chi M (2001) Bilateral small radial forearm flaps for the reconstruction of buccal mucosa after surgical release of submucosal fibrosis: a new, reliable approach. Plas Reconstr Surg 107(7):1679–1683

    Article  Google Scholar 

  40. Tsao C-K, Chang F-C-M et al (2010) Reconstruction of the buccal mucosa following release for submucous fibrosis using two radial forearm flaps from a single donor site. JPRAS 63(7):1117–1123

    PubMed  Google Scholar 

  41. Noha O, Mohammed A (2021) Comparaison between radial forearm free flap (RFFF) and anterolateral thigh (ALT) flap in head and neck reconstruction. Egypt J Plast Reconstr Surg 45(4):281–289

    Google Scholar 

  42. Huang JJ, Wallace C, Lin J, Tsao C et al (2010) Two small flaps from one anterolateral thigh donor site for bilateral buccal mucosa reconstruction after release of submucous fibrosis and or contractor. J Plast Reconst Aesthet Surg 63(3):440–445

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Dentistry, Al-Azhar University, Gaza Strip, Gaza, Palestine

    Hossam Waleed Al-Madhoon

  2. Faculty of Dentistry, Tanta University, Tanta, Egypt

    Amr Elkhateb

  3. Faculty of Medicine, Zagazig University, Sharkia, Zagazig City, Egypt

    Moamen Mostafa Asla

  4. Surgical Sciences Department, College of Dentistry, Ajman University, P.O Box 346, Ajman, United Arab Emirates

    Mohamed Jaber

Authors
  1. Hossam Waleed Al-Madhoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amr Elkhateb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moamen Mostafa Asla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed Jaber
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hossam Waleed Madhoon, Amr Elkhateb, Moamen Mostafa Asla, and Mohamed A. Jaber. The first draft of the manuscript was written by Hossam Waleed Madhoon, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Mohamed Jaber.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 17 KB)

Supplementary file2 (DOCX 17 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al-Madhoon, H.W., Elkhateb, A., Asla, M.M. et al. Comparative evaluation of nasolabial flap and buccal fat pad flap in the surgical management of oral submucous fibrosis: a systematic review and meta-analysis. Oral Maxillofac Surg 28, 91–100 (2024). https://doi.org/10.1007/s10006-023-01157-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10006-023-01157-3

Keywords

Search

Navigation