Comparative Efficacy of Buccal Fat Pad Flap Versus Buccal Advancement Flap in Oro-Antral Fistula Closure: A Prospective Study at Obafemi Awolowo University Teaching Hospital

Oro-antral fistula (OAF) is a persistent communication between the oral cavity and the maxillary antrum that develops from untreated or recurrent oro-antral communication, often requiring surgical repair using local flap techniques. The two most widely employed repair techniques in Nigeria, the buccal fat pad (BFP) flap and the buccal advancement flap (BAF), have been individually reported in the literature, but direct comparative data from African tertiary institutions are scarce. This prospective randomized controlled trial compares the success rate, postoperative morbidity, and patient satisfaction of BFP flap versus BAF for OAF closure at Obafemi Awolowo University Teaching Hospital, Ile-Ife, South West Nigeria. Fifty patients with confirmed OAF were randomized into two groups of 25. Primary outcome was fistula closure success at eight weeks; secondary outcomes included wound infection, mucosal color match, facial contour change, and patient-reported satisfaction. Results indicate comparable primary closure rates between the two techniques (BFP: 88%, BAF: 84%), though BFP demonstrated superior mucosal color match and lower donor site morbidity. The BFP flap was associated with a marginally shorter operative time. The study provides the first randomized comparative data on these techniques from a South West Nigerian institution and supports the BFP flap as the preferred technique for medium to large OAFs. Keywords: oro-antral fistula, buccal fat pad flap, buccal advancement flap, randomized trial, maxillary sinus.