الفهرس 
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Abstract
The objective of this study was to evaluate the treatment of oroantral fistulous defects using the buccal antrostomy wall as a bone graft fixed by N butyl cyanoacrylate (histoacryl) and buccal advancement flap.
The study included 10 patients selected according to inclusion and exclusion criteria from those admitted to the Oral and Maxillofacial Surgery Department ,Faculty of Dentistry, Alexandria University
Patients’ evaluation
All patients were evaluated as follows:
- History, including present history of the recent extraction and /or cause of the oroantral fistula, and past medical history
- Clinical examination including both extra oral and intra oral examination.
- Radiographic examination using cone-beam computerized tomography (CBCT).
Surgical procedures
- Decoring of the fistulous tract.
- Reflection of buccal mucoperiosteal trapezoidal flap.
- Curettage of the affected membrane of the maxillary sinus and removal of granulation tissue, polypoids, and remaining roots.
- Caldwell-Luc procedure was done as follows:
- An area of anterior maxillary sinus wall at the canine fossa was outlined with methylene blue and the piezotome was used to harvest the buccal antrostomy bone for grafting.
- The graft outlined for harvesting was well marked away from maxillary teeth apices, pyriform aperture and infraorbital foramen to avoid inadvertent trauma to these vital structures.
- The thickened lining of the maxillary sinus was removed and irrigation of the maxillary sinus was carried out with copious saline wash.
- The bone graft was press -fitted into the defect and fixed by N-Butyl
- cyanoacrylate (Histoacryl®). The periosteum on the under surface of the
- flap was incised horizontally at the base of the flap to allow advancement
- of the flap and the buccal flap was repositioned and advanced to be sutured
- with palatal mucosa without tension.
- Clinical and radiographic follow up
Clinical evaluation was done for each patient at 1 week, 4 weeks, 6 weeks, 8 weeks and 12 weeks postoperatively. The patients were examined for postoperative bleeding, infection, and wound healing.
Radiographic evaluation was done at 3 months by CBCT to examine for bone formation.
Clinical and radiographic results
Evaluation of the patients revealed that proper healing of the wound occurred in all of the patients. Regarding the bone graft, only 2 patients had exfoliation of the bone graft after one month with no reopening of the fistula.
Radiographically, significant amount of bone was formed comparing the preoperative and postoperative CBCT of the study group.