Palatal Perforation Research Articles

Management of palatal perforation in systemic lupus erythematosus patient

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease which damages tissues and causes chronic inflammation with an idiopathic etiology. It has been suggested that oral lesions in patients with SLE can be grouped clinically as erythema, discoid lesions and oral ulcerations. The latter have been said to indicate the onset of a severe systemic disease flare and that oral ulcers represent cases of mucosal vasculitis. Palatal lesions generally present in the form of ulcers or, in more severe forms, as perforation. Acquired palatal perforations can be caused by several etiologies including: developmental disorders, malignancy and infections. Purpose: To report the management of palatal perforation in an SLE patient. Case: A 14-year-old female patient attended the Dr. Ramelan Naval Hospital, with both a perforated palate that often caused her to choke when eating or drinking and maxillary anterior tooth mobility. Case Management: The treatment for the patient in this case consisted of debridement and DHE, pharmacological therapy including aloclair gel and minosep mouthwash to maintain oral hygiene and prevent re-infection. At the end of the first consultation, the patient was prescribed an obturator in order to avoid oro-anthral infection. During the second consultation, the patient’s orthodontic bracket was removed to facilitate scaling and splinting of the anterior maxillary teeth carried out to prevent their movement. During the third consultation, a swab was taken by an oral surgeon who also administered antifungal therapy. During the fourth and final consultation, the patient was examined a prosthodontic specialist due to an obturator which was causing discomfort. Conclusion: The management of palatal perforation lesions in an SLE patient requires a multidisiplinary approach.

Surgically assisted rapid palatal expansion in class III malocclusion: Our experience

IntroductionMaxillary transverse deficiency (MTD) is a common facial disharmony that may need surgical assisted rapid palatal expansion (SARPE). The aim of this study was to present our SARPE technique and to report about our experience. Materiel and MethodMedical records of all class III patients who underwent SARPE in our department from 2010 to 2015 and for whom a follow-up of at least 1year was available, were included in a retrospective study. The technique consisted, after short orthodontic preparation allowing for divergence of the upper central incisors, in a complete Le Fort I osteotomy without down fracture, and medial sagittal submucosal separation of the hard palate under general anesthesia in an inpatient procedure. Teeth-supported distracters were sealed preoperatively while bone-supported devices were inserted peroperatively. Activation of the distracter was allowed from day 2 at the rate of 2×0.25 per day during 4days and 2×0.5mm per day the following days. Distracters were left in place for about 4months. Orthodontic treatment resumption was allowed from the second month. The initial malocclusion, the amount and type (parallel or angular) of distraction that was needed, the type of distracter used, the amount of distraction obtained, the per- and postoperative complications and the clinical stability of the end result were analyzed. ResultsThe records of 23 patients (18 women, 5 men – average age: 25.4years, extremes: 16–55years) could be included. MTD was isolated in 6 cases, associated with a maxillary retrognathism in 5 cases, with a mandibular prognathism in 6 cases, and with both in 6 cases. The average amount of distraction needed was 7.2mm (range: 4–12), parallel in 20 cases and angular in 3 cases. The distracters were bone-supported (Rapid Palatal Expander®, KLS Martin Group, Tuttlingen, Germany) in 3 patients and custom-made tooth-supported in 20 patients. The average amount of distraction obtained at the level of the distracter cylinder was 7.7mm (range: 5–13). We noted 2 cases of palatal fibromucosa perforations, 1 case of posterior excess of distraction, 1 case of nasal septum deviation, 1 case of iatrogenic necrosis of tooth No.°11, 1 case of naso-genial sulcus hematoma, 1 case of intraoperative mobility of tooth No.°21, 5 cases of asymmetric distraction. Seventeen patients needed a second orthognathic procedure and 22 had stable Class I occlusion after removal of appliances at 18 months follow-up on average. DiscussionSARPE is a quite safe procedure that allows for transverse coordination without dental extraction. Transverse discrepancies greater than 4mm are for us clear indications for SARPE. When a sagittal discrepancy is associated, we prefer performing SARPE first and correcting the sagittal plane in a second operation. The recent development of Le Fort I sliding osteosynthesis plates opens the way to one time correction and the development of double-action distracters fitted out with 2 cylinders will be helpful for performing angular distractions.

Effect of azithromycin on fetal development in rats

This study was designed to evaluate the potential risks of the Azithromycin administration on fetuses. Therefore pregnant rats were received Azithromycin orally (90 and 180 mg/kg b.wt, daily) from sixth day until the fifteenth day of gestation. At 20th day of gestation female sacrificed; abortion, fetal resorptions, visceral examination, skeletal examination, Oxidative stress markers and histopathological examination for fetuses were recorded. Azithromycin caused abortion, fetal resorptions, growth retardation, hematoma and paralysis of limbs. Also caused cerebral dilatation, microcephaly, perforation of hard palate and hemorrhage around internal organs. By skeletal examination; weak and incomplete ossification were observed in bones .Biochemical studies showed that Azithromycin administration resulted in decreased glutathione reduced but increased malonaldahyde compared to control groups. Fetal kidney revealed degeneration and necrosis in the tubular lining epithelium and fibrosis in between the atrophied renal tubules. This study supports and proofs the potential risks of the azithromycin administration on fetuses. Â

Perforation of Palate in Granulomatosis With Polyangiitis

Perforation of Palate in Granulomatosis With Polyangiitis

Combined Modality Treatment with “Dexamethasone, Methotrexate, Ifosfamide, L-Asparaginase, and Etoposide ” Chemotherapy and Involved Field Radiotherapy for Early Stage Natural Killer/T Cell Lymphoma with Local Tumor Invasiveness: A Single-institution Study from India

Abstract Context: Patients with early stage extranodal natural killer/T-cell lymphoma, nasal type (ES-NKTCL) and local tumor invasiveness (LTI) show poor treatment outcomes with standard approaches. Dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) is an intensive, highly active protocol mainly studied in advanced/recurrent disease. No prior study has utilized this protocol in high-risk ES-NKTCL. Methods: Between 2011 and 2016, all patients with ES-NKTCL with LTI at presentation were uniformly treated at our institute with a combination of SMILE chemotherapy for 5–6 cycles, and involved-field radiotherapy (IFRT). Records of these patients were retrospectively reviewed. Results: Sixteen patients were identified, 69% stage IE and 31% stage IIE. The majority of patients had B-symptoms (75%), paranasal sinus (PNS) invasion (81%), facial skin invasion (56%), palatal perforation (69%), or orbital extension (56%). 12/16 had B-symptoms, and 6/16 had elevated lactate dehydrogenase. All patients received the entire planned 5–6 cycles. IFRT was delivered after a mean 4 cycles. Complete remission was achieved in 13/15 (87%) patients. At a median follow up of 18.5 months, 1-year progression-free survival and overall survival was 84% and 94%, respectively. Grade 3–4 toxicity was seen in 81%, most commonly neutropenia (75%), anemia (44%), and thromobocytopenia (31%). Six patients required dose adjustments (predominantly in the first 1 or 2 cycles). No treatment-related mortality was noted. Conclusion: SMILE with RT is a toxic but tolerable protocol for ES-NKTCL with LTI with high efficacy. Prospective studies are warranted.

A Case of Pharyngeal Actinomycosis with Soft Palate Perforation

A Case of Pharyngeal Actinomycosis with Soft Palate Perforation

Soft obturator prosthesis for postoperative soft palate carcinoma: A clinical report

An intraoral prosthesis with a soft flexible obturator was provided for a patient with a soft palate perforation after surgical and chemoradiotherapy treatments of a soft palate tumor. An obturator composed of movable and flexible silicone was attached to a structure similar to a palatal lift; it was therefore able to move according to the movement of the soft palate, which was confirmed by endoscopic examination. The application of this prosthesis resulted in complete disappearance of hypernasality and food reflux, and the patient was able to eat without particular limitation during daytime wearing. This type of prosthesis represents a potential prosthetic approach to a soft palate nasal-oral fistula.

COCAINE OSTEONECROSIS – EXPOSED, MRONJ-LIKE BONE FROM ORAL PLACEMENT OF COCAINE & CRACK POWDER

Nasal septal & hard palate perforation can occur from snorting cocaine. It has been revealed that some users repeatedly place moistened cocaine or crack powder under the upper lip or in the posterior mandibular vestibule, adjacent to alveolar mucosa.

Palate perforation differentiates cocaine-induced midline destructive lesions from granulomatosis with polyangiitis.

SUMMARYCocaine abuse occasionally causes extensive destruction of the osteocartilaginous structures of the nose, sinuses and palate, which mimics the clinical picture of other diseases associated with necrotising midfacial lesions. The differentiation of cocaine-induced midline destructive lesions (CIMDL) and limited granulomatosis with polyangiitis (GPA) may be difficult, particularly if patients do not readily admit substance abuse. We studied 10 patients with CIMDL and palate perforation referred to our Unit between 2002 and 2015. All cases underwent nasal endoscopy, sinus CT or MRI and ANCA test. In 8 patients, a nasal biopsy was performed. The PubMed database was searched to review all cases of palate perforation described in patients affected by CIMDL or GPA. All 10 cases presented with septal perforation and inferior turbinate destruction. We found hard palate perforation in 7 patients, soft palate perforation in 2 patients, and perforation of both in one patient. ANCA testing was negative in 8 patients and positive in 2, with C-ANCA and P-ANCA specificity, respectively. A review of the English literature identified palate perforation in 5 patients with GPA and in 73 patients with CIMDL. The presence of palate perforation in patients with MDL may represent a clinical marker that strongly favors CIMDL over GPA.

診断に苦慮した軟口蓋穿孔の 1 例

診断に苦慮した軟口蓋穿孔の 1 例

Aggressive natural killer cell leukemia or extranodal NK/T cell lymphoma? a case with nasal involvement

BackgroundAggressive natural killer cell leukemia/lymphoma (ANKL) is a rare and highly aggressive NK cell neoplasm with a short clinical course and poor prognosis and is often misdiagnosed and confused with NK/T cell lymphoma (NKTL), which has a very different prognosis. Here, we present a case with nasal and bone marrow involvement, provide a literature review and make a differential diagnosis.Case presentationA 41-year-old male presented nasal congestion pharyngalgia, palatal perforation, high fever and multiorgan dysfunction. Our diagnosis primarily relied on clinical features, the morphology and immunophenotype of the neoplastic cells and imaging studies. Characteristic large granular lymphocytes with azurophilic granules were visible in the bone marrow smears. In addition, the neoplastic cells expressed a typical immunophenotype, and the T cell receptor γ (TCR-γ) gene rearrangement analysis and presence of Epstein-Barr virus (EBV) were negative. The patient’s symptoms and signs were temporarily relieved after chemotherapy treatment, but after a short time, he underwent a rapid clinical decline and died 8 weeks later after admission due to multiorgan function failure.ConclusionOur case demonstrates that to avoid a misdiagnosis, bone marrow analyses and other examinations should be performed early when a patient initially presents nasal lesions and other systemic symptoms. To the best of our knowledge, this may be the first reported case of ANKL with sternal tenderness.

Juvenile Nasopharyngeal Angiofibroma: Combined Approach for Excision, Transpalatal and Endoscopic; A New Perspective.

Juvenile angiofibroma is a rare, highly vascular, histologically benign but locally invasive tumour, affecting predominantly male adolescents. To describe our experience in diagnosis of angiofibroma and treatment by combined endoscopic and transpalatal route. We analysed a case series of 50 patients of nasopharyngeal angiofibroma in Fisch stages I and II who presented at our institute during a period of four years 2011-2014, their clinical presentation, their treatment by combined transpalatal and endoscopic approach, intraoperative and post operative course, complications and tumour recurrence. Patients were aged 8-26years. All patients were treated surgically by combined approach endoscopic and transpalatal. The mean operation time was 90min, and the mean bleeding volume was 300ml. Only 8% patients came with recurrence and only 10% came with palatal perforation (fistula formation). With gratifying results we advocate this novel technique for the treatment of early to intermediate JNA.

Large radicular cyst with both buccal and palatal cortical bones perforation secondary to vital pulp therapy failure

Radicular cyst as the most common odontogenic cyst usually arises from residual epithelial cells stimulated by inflammatory factors initiating by pulpal necrosis of a non-vital tooth. Radicular cyst is commonly asymptomatic, slow grower, and rarely invade near bony structures. Many treatment approaches are presented for a radicular cyst like surgical endodontic treatment, tooth extraction, enucleation, and marsupialization. In this case treatment plan compromised with root canal therapy and surgical enucleation of cystic lesion. This case report presents a large radicular cyst in a vital maxillary first molar with only one necrotic root canal secondary to direct pulp capping with mineral trioxide aggregate with buccal and palatal cortical bone perforation.

Recurrent Extranodal NK/T-Cell Lymphoma Presenting as a Perforating Palatal Ulcer and Oro-Nasal Fistula.

Nasal-type extranodal natural killer/T-cell lymphoma (ENKTL) is a rare disease presenting with non-specific symptoms, typically originating in the nasal cavity, palate, or midfacial region. Oral cavity is an extremely rare site for this type of lymphoma. In this report, we present a case of palatal perforation and oro-nasal fistula as a manifestation of recurrent ENKTL. Complicated disease entity should be considered when surgeons deal with palatal perforation and oro-nasal fistula.

Uncommon associations with cleft palate: Plausibility of postclosure opening as a cause of cleft palate

ObjectiveCurrent consensus from numerous animal studies has emerged that disturbances at any stage of palatal development can cause cleft palate. However, several clinical cases of uncommon forms of cleft palate that may have resulted from rupture after palatal fusion have been previously reported and treated. This hypothesis of postclosure opening as a cause of cleft palate was reviewed in the literature. Materials and methodsWe reviewed Japanese and English-language literature describing uncommon forms of cleft palate, which included palatal remnants, perforation, and divided nevi. In addition, a retrospective chart review of over 1300 cleft palate repairs performed by the authors was done. ResultsThere were many reports of palatal remnants and perforations, but no reports of divided nevi on the cleft palate. Our retrospective chart review revealed that 12 cases may have resulted from postclosure opening, with 5 cases due to epithelial remnants on the hard palate, 5 cases of cleft palate with perforation, 1 case of a palatal sinus, and 1 case of a divided nevus over the cleft. ConclusionsEpithelial remnants did not seem to be evidence of a postclosure opening event, because they were found in 23–85% of intact palates. However, perforation of the hard palate and a divided nevus on the cleft cannot be explained by embryology, which might indicate postclosure opening as a cause of the cleft. Clinical or animal studies are required to test this hypothesis further.

Nasal myiasis presented with palatal perforation: a Case report

Myiasis is rare disease of nose. In this case report we present a 47 years female with nasal myiasis along with palatal perforation which was managed conservatively with antibiotics, manual removal of maggots and planned for closure of oro-nasal fistula later. Later on the bleeding was gradually controlled. Patient was advised for imaging of nose and paranasal sinuses. The imaging showed soft tissues densities in the bilateral nasal cavity with erosion of nasal septum, hard palate and soft palate with oronasal fistula formation

Penetrating soft palate injury during nasotracheal intubation

SummaryNasotracheal intubation is generally a safe procedure for securing a definitive airway prior to oropharyngeal surgery. However it is associated with specific injuries that range from minor mucosal injury, to retrophayngeal perforation leading to death. We report a rare case of soft palate perforation during conventional nasotracheal intubation and discuss measures to avoid its occurrence.

Oncology Institute of Guatemala: Experience With NK/T-Cell Lymphomas

Abstract 24 Background: NK/T-cell nasal type lymphoma is an aggressive non-Hodgkin lymphoma that destroys the palate and nasal anatomy. The incidence in the US and Europe is very low; however, Asia and South America have reported incidence up to 10-15%. This study was done to assess the incidence of this type of lymphoma in our institution, outcomes of treatment efficiency, and to explore demographic, clinical and biological characteristics associated with poor outcomes. Methods: Seventeen NK/T-cell lymphoma patients were diagnosed between 2014-2015, who were treated with radiotherapy plus weekly cisplatin 3-5 doses and consolidation with gemcytabine, oxaliplatin y L-asparaginase 1-4 doses or cisplatin, etopóside, ifosfamide and dexamethasone by 3 doses. Results: The incidence of NK/T-cell lymphoma was 9% of all lymphomas. Median age was 35 years (range: 20-64). The nose is the most frequent location (94.1%,16/17), and 23.5% (4/17) presented with high tumor burden. 100% of these patients presented with palate perforation. One patient presented with stage IV disease. All patients with high tumor burden and stage IV disease died with an overall survival (OS) of 5 months. Three of the deceased were Mayan people (75%). Guatemala's region with the highest incidence was Central (58%) and West (35.3%) vs. North, South and East (5.8%). 65% of the cases were Mayan people vs. 35% of mestizos. All patients had a poor or very poor socio-economic status. Twelve patients achieved complete response (70.6%). After a median follow-up time of 11 months, 1-year event-free survival and OS were 64.7%. Conclusions: The results of this study lead us to the conclusion that Guatemala's indigenous population in the west and center of the country are the most vulnerable population, which include mainly people with a poor socio-economic status. High tumor burden was associated with poor outcomes. Results achieved with radiotherapy plus cisplatin and consolidation with chemotherapy was effective. We recommend the development of educational programs to encourage early diagnosis of this lymphoma in areas of the population that are at risk. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Fabiola Valvert Travel, Accommodations, Expenses: Kedrion Biopharma, Asopharma Diana Flores No relationship to disclose

Palate Perforation

Palate perforation is a rare condition and can be due to congenital or acquired causes. Acquired palatal perforations can be caused by a number of etiologies including developmental disorders, infections, malignancy, and drugs of abuse. We present a case of palatal perforation due to NK/T-cell lymphoma, which presented in a manner mimicking an aggressive infectious process. The infectious and noninfectious causes of palatal perforation and their differentiation are emphasized in this case study.

“Proposed Classification for the Palatal Perforation” (Dr. Santosh Patil Classification)

The palate is an integral part of the oral cavity constituting various tissue types that give rise to different types of pathological conditions. Palatal perforation can be defined as a communication between the nasal cavities and the oral cavity. Palatal perforation is a rare condition encountered in the routine dental practice. It is well understood that the palatal perforation can pose a difficult diagnostic dilemma for the clinician. The perforation may present with the common characteristics and may be indistinguishable clinically. Emphasis is placed on the importance of obtaining a thorough and comprehensive history and collecting relevant laboratory information. Palatal perforation may be known to arise secondary congenital or acquired causes. During the sixth week of prenatal period palatal shelves may fail to fuse leading to cleft palate [1]. Acquired palatal perforations may be seen due to trauma, infectious disease, granulomatous disease, drug abuse, collagen vascular diseases and neoplastic conditions. Adenoid cystic carcinoma is reported to cause palatal perforation in many cases [2]. Tumors from maxillary sinus or nasal cavity may extend to palate leading to its perforation [3,4]. Although these neoplasms usually form a mass, but in advance cases perforation of palate may occur in course of disease or following treatment [5,6]. Various cases of palatal perforation due to narcotics abuse are reported in literature [7-9] (Table 1). Surgical procedures such as maxillectomy, septoplasty or intubation may lead to palatal perforation [10,11]. Till date there is no classification given for the palatal perforation, classification of disease makes it easier to study and understand which helps in timely diagnosis leading to the best prognosis for the patient. With this objective the following classification based on the etiological conditions has been proposed after a brief review of various causative factors for palatal perforations existing literature.