To compare the functional and patient-centred outcomes of buccal fat pad (BFP) versus full-thickness skin graft (FTSG) for intraoral reconstruction following fibrotomy in advanced oral submucous fibrosis (OSMF).

This retrospective observational comparative study included OSMF patients surgically treated between January 2022 and March 2025 who underwent fibrotomy with reconstruction using either BFP or FTSG and had a minimum follow-up of 6 months. Data were extracted using standardised forms and validated by two investigators. The primary outcome was maximum interincisal opening (MIO), measured preoperatively and during follow-up. Secondary outcomes included operative duration, graft uptake, mucosalization time, postoperative complications, donor-site morbidity, recurrence of fibrosis, and patient satisfaction assessed on a 5-point Likert scale at 6 months.

Twenty-eight patients met the inclusion criteria and were analysed. Baseline demographics and disease grades were comparable between groups. Both groups showed marked improvement in MIO postoperatively, with no statistically significant intergroup difference at follow-up. Mucosalization was significantly faster in the BFP group (4.8 ± 0.7 weeks) compared to the FTSG group (10.4 ± 2.0 weeks) (p < 0.05). Operative duration was significantly shorter with BFP (124.3 ± 8.6 minutes) than with FTSG (148.7 ± 6.9 minutes) (p < 0.05). Patient satisfaction scores were comparable between groups (median 4; p = 0.393). Donor-site morbidity was observed only in the FTSG group.

Both BFP and FTSG provide effective scarless intraoral reconstruction after fibrotomy in advanced OSMF, with comparable functional outcomes and patient satisfaction at 6 months. BFP offers advantages of faster mucosalization and shorter operative time, while FTSG remains a useful alternative when BFP reach or volume is inadequate.