What is the best initial treatment for a maxillary oroantral fistula?

The best initial treatment for a maxillary oroantral fistula is focused on addressing the infection and promoting healing. In this case, administering antibiotics and performing irrigation helps eliminate any bacteria that may be present and cleans the area around the fistula. Addressing an infection is a crucial first step in managing an oroantral fistula, as this condition often arises due to dental extractions, trauma, or infections that compromise the integrity of the maxillary sinus and the oral cavity.

While surgical closure could ultimately be necessary for a definitive restoration of normal anatomy, it is typically not the first approach when there's an active infection. Irrespective of potential surgical options, infection control must be prioritized before any surgical intervention can be effectively planned. Similarly, topical antiseptic may help with local hygiene, but it does not provide the systemic control of infection that antibiotics do. Pain management, while important, does not address the underlying issue of the fistula and its associated complications.

Thus, starting with antibiotics and irrigation provides an appropriate initial response, paving the way for future interventions, including possible surgical closure after the infection is resolved, ensuring a more successful outcome.