The objective of this study was to assess the efficacy of utilizing pedicled buccal pad of fat (BPF) through three- layered approach for closure of large, chronic oroantral fistula (OAF). OAF as an inadvertent sequalae of posterior Maxillary surgery or trauma, represents a significant problem to patients and clinicians. This complication may be caused by impacted tooth odentectomy, enucleation of large Maxillary cyst or tumor of following jaw infection. It's usually followed by Maxillary sinusitis that have to be managed before closure of this pathological communication. Pedicled BPF is a readily available, abundant type of flap with no donor site morbidity and good blood supply. Patients & methods: BPF was utilized as an intermediate layer in a three- layered approach to manage the soft tissue component of the OAF. Assessment included the clinical soft tissue healing, pathological assessment of specimen of the fistulous tract and recurrence of the fistula if any; which was monitored one week and three months postoperatively. Results: The study population included five patients. Healing went uneventful in all cases without dehiscence, vestibular depth compromise or recurrence of OAF. Conclusion: Within the limitations of the current study, it seems that the pedicled BPF technique is simple, easy, versatile one. It represents a promising alternative to different local and regional flaps for closure of OAF with successful results. A study with larger sample size is recommended by the authors.