Question

A patient with a radiographically confirmed chronic oroantral fistula presents with nasal pus dischargeWhat would be the most appropriate treatment option?

• A. Administer antibiotics, excise the epithelial lining, and close the defect using a local flap
• B. Use an acrylic plate with antibiotics and monitor for spontaneous healing
• C. Apply titanium mesh with a buccal flap and buccal fat pad for closure
• D. Perform pus culture, sinus lavage, start empirical antibiotics, and allow spontaneous closure

Hint:

Oroantral fistula + Sinus infection → First treat infection → Then consider closure.

Answer 1

The Correct Option is D

Step 1: Understanding the Clinical Condition.
A chronic oroantral fistula is a persistent communication between the oral cavity and maxillary sinusThe presence of nasal pus discharge indicates associated maxillary sinus infection (sinusitis)
Step 2: Initial Management Priority.
Before attempting surgical closure, the sinus infection must be controlledClosing the fistula in the presence of active infection may lead to failure of treatmentTherefore, management should focus first on eliminating infection
Step 3: Appropriate Treatment Approach.
The correct approach includes performing pus culture to identify the causative organismSinus lavage helps remove purulent materialEmpirical antibiotics are started and later adjusted based on culture resultsOnce infection subsides, spontaneous closure may occur or definitive closure can be planned
Step 4: Excluding Other Options.
Immediate surgical closure without controlling infection risks recurrence
Acrylic plate alone does not treat sinus infection
Titanium mesh is unnecessary in routine cases and does not address infection first
Step 5: Conclusion.
Since infection control is the primary step in management, the correct answer is Perform pus culture, sinus lavage, start empirical antibiotics, and allow spontaneous closure