Buccal Fat Pad for Management of Cerebrospinal Fluid Leakage Using Endoscopy: A Randomized Clinical Trial

Background and Aim: Several surgical techniques have been so far used for treating Cerebrospinal Fluid (CSF) leakage (rhinorrhea) such as using abdominal fat or fascia lata, but these methods have complications such as the presence of several surgeons in variable fields in the operating room or cosmetic complications for donors such as the surgical scar. This study aimed to investigate using buccal fat pad for management of traumatic CSF leakage. Methods and Materials/Patients: In this clinical trial, 46 patients with traumatic CSF leakage were enrolled according to inclusion criteria and randomly divided into intervention and control groups. Buccal fat pad for the intervention and abdominal fat for the control were inserted in the defect of the anterior cranial cavity by applying endoscopic sinus surgery. The patients were followed up for 1 year postoperatively. Results: All patients were improved with no recorded report of CSF leakage relapse. In the intervention group, temporary complications such as edema (18.2%), numbness (9.1%) and facial asymmetry (9.1%) were observed in resected buccal fat pad areas. Also the control group all developed abdominal scar. The duration of surgery in the intervention group was significantly shorter than control (P=0.02). Conclusion: Using buccal fat pad for management of CSF leakage is a highly effective and reliable method which requires simple procedure with low cosmetic complication and short duration of surgery compared with other methods such as an abdominal fat graft. In addition, using buccal fat pad has better cosmetic results, so we suggest this surgical method for patients with CSF leakage