What is the best treatment for a persistent oroantral fistula that has lasted for 12 weeks?

The recommended treatment for a persistent oroantral fistula that has lasted for 12 weeks is excision of the fistula and surgical closure. This is because a fistula persisting beyond several weeks is unlikely to resolve on its own due to the established communication between the oral cavity and the maxillary sinus.

Surgical intervention is necessary to remove the diseased tissue and promote proper healing. By excising the fistula, the underlying cause of the fistula can be addressed, and the surrounding tissues can be adapted to close the defect effectively. This approach minimizes the risk of recurrent fistula formation and complications such as chronic sinusitis, which can result from a fistula that remains untreated.

Options like further review and reassurance may be appropriate for short-lived or small fistulas; however, given the duration of 12 weeks, this option is not suitable as the fistula may not heal on its own. Likewise, antibiotic therapy and nasal decongestants, while they may help with secondary infections or sinus issues, do not directly address the fistula itself. Curettage and dressing might provide temporary relief but are not definitive treatments for a persistent condition. Thus, surgical intervention provides the most effective means of resolution in this case.