RESUMO
Aims: To present failed rotational palatal flap of a severe rheumatoid arthritis patient with a chronic oroantral fistula and a practical surgical method to deal with the systemic outcomes. Presentation of Case: Bone necrosis at donor site in closure of oroantral fistulas with palatal rotational flap is known to be very rare. We present a 57 years old female, rheumatoid arthritis patient under Methotrexate medication, with a chronic oroantral fistula in the left first molar region. Bone necrosis has been shown at the donor site after full thickness palatal rotational flap procedure. The treatment approach and alternative methods are discussed. Bone necrosis on the donor site has been treated with the re-rotation of the palatal rotational flap tissues, but this time with partial thickness to its original position. Successful healing has been achieved. Discussion and Conclusion: The result of this approach could help practitioners challenging with rheumatoid arthritis caused healing problems and oroantral fistulas.