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Oroantral Communication Management — MFDS Part 1 MCQ

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ModerateOral Surgery PrinciplesOroantral Communication ManagementMFDS Part 1

In an oral surgery clinic, a fresh oroantral communication is identified immediately after extraction of an upper second premolar. The defect is approximately 6 mm across, and the socket margins cannot be approximated without tension. There is no displaced root, purulent discharge or clinical evidence of sinusitis. The operator is competent to perform local flap closure. What is the most appropriate immediate management?

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

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Correct answer: B — Obtain tension-free primary closure with a buccal advancement flap, then provide sinus precautions and arrange review

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

A is correct. This is a fresh 6 mm oroantral communication whose margins cannot be approximated without tension. Defects over approximately 5 mm generally require prompt surgical closure; a tension-free buccal advancement flap is an established local technique. The patient should also receive sinus precautions, including avoiding nose blowing and straws and sneezing with the mouth open, with subsequent review. A haemostatic dressing or simple socket suturing may be sufficient for a small defect but is unreliable here. Antibiotics do not close the communication and are not a substitute for local treatment; their use depends on infection and procedural factors. Routine referral without initial treatment is unnecessary because the operator is competent and there is no displaced root or sinus disease requiring specialist exploration.

Reference: Calderdale and Huddersfield NHS Foundation Trust Maxillofacial Unit. Oro-Antral Communication (OAC): Advice Leaflet, version 1, review date June 2027. https://plr.cht.nhs.uk/download/1418/Oro%2520antral%2520communication%2520OAC%2520A4