Oro-Antral Fistula — ORE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModerateOral SurgeryOro-Antral FistulaORE Part 1

A patient attends 4 weeks after extraction of an upper first molar. They have a persistent oro-antral fistula. There is no evidence of acute sinus infection. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Surgically close the fistula with a buccal advancement flap

The correct answer is E. By 4 weeks, persistence indicates an established oro-antral fistula rather than a fresh oro-antral communication. Definitive management is surgical closure after assessment of the sinus and local tissues; a buccal advancement flap is a conventional, appropriate local-flap technique. Observation is unsuitable because spontaneous closure is expected only for selected fresh, small communications, not an established fistula. BIPP packing does not provide definitive closure of an epithelialised tract. Antibiotics alone do not eliminate the communication and would be adjunctive only if sinus infection were present. An obturator can have a role where surgery is unsuitable or as an interim measure, but it is not first-line definitive management in this otherwise straightforward post-extraction fistula.

Reference: Ciaccia L et al. The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis. 2024. https://pubmed.ncbi.nlm.nih.gov/38786545/