The primary aim of treatment of a newly formed<unk>  communication is to prevent the development of an<unk>  as well as chronic sinusitis. The decision on how to treat OAC/OAF depends on various factors. Small size communications between 1 and 2 mm in diameter, if uninfected, are likely to form a clot and heal by itself later. Communications larger than this require treatments to close the defect and these interventions can be categorised into 3 types: surgical, non-surgical and pharmacological. Surgery Surgical methods are required if a large defect is present or if a defect persists. Surgery involves creating a flap utilising local tissue to close the communication. There are a number of different flaps that can be used such as the buccal advancement flap, the buccal fat pad flap, a combination of the two and a palatal flap. The flap used is dependent on the size and position of the defect. Buccal advancement flap The buccal advancement flap is the most commonly used due to its simplicity, reliability and versatility. It involves cutting a broad based trapezoid shaped mucoperiosteal flap with two vertical incisions. The flap is cut buccally, is three sided and extends to the full depth of the sulcus. Buccal fat pad flap The buccal fat pad flap is also a popular option due to its high success rate. It is a simple procedure where the buccal extension of the anatomical fat pad is used for closure. These two flaps can be used in combination where the buccal fat pad covers the communication followed by a further covering via the buccal mucosal flap described above. This double layer flap has advantages over a single layer as it provides stable soft tissue covering, reduces the incidences of wound breakdown and defect recurrence as well as reducing the risk of postoperative infection. Sutures, either non-resorbing or slowly resorbing, are generally used in the surgical repairs of OAC. Non-surgical interventions Ultimately, surgery is usually required to close an OAC/OAF. However, if surgery is not immediately available then non-surgical methods can be used to encourage the growth of oral mucosa between the oral cavity and the antrum. The aim of these methods is to protect the blood clot within the socket and help to prevent infection. One option is construction of a denture with an acrylic base plate or extension of the patient’s existing denture to protect the socket and support the clot. These options are particularly helpful in patients who smoke as it provides protection from smoke inhalation. The socket can also be sutured over with mattress sutures if there is adequate soft tissue available. Medication Medications may be needed as an adjunct to assist the closure of the defect. Antibiotics can help control or prevent any sinus infections. Preoperative nasal decongestants usage can reduce any existing sinus inflammation which will aid surgical manipulation of the mucosa over the bone. Postoperative care Following all methods of OAC/OAF closure, the patients are instructed to avoid activities that could produce pressure changes between the nasal passages and oral cavity for at least 2 weeks due to risk of disruption to the healing process. Nose blowing and sneezing with a closed mouth are prohibited. A soft diet is also often advocated during this period. Following surgery, nasal decongestants and prophylactic antibiotics are often prescribed to prevent postoperative infection.
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