Palatal Perforation Research Articles

Palatal Perforation Secondary to Tertiary Syphilis: An Uncommon Presentation and Diagnosis of Exclusion

Syphilis is re-emerging as a leading sexually transmitted disease among patients living with acquired immune deficiency syndrome [AIDS]. Dental practitioners are very often seen oral abnormality in the form of palatal perforation but it is very unlikely to see palatal perforation as sole manifestation of tertiary syphilis. Here we present a 36 years old male patient presented with hard palate perforation without any other oral or systemic complaints. Purpose of this case report is to aware dentist about emergence of syphilis as a cause of oral cavity ailment.

Management of a cocaine-induced palatal perforation with a nasal septal button

A cocaine-induced midline destructive lesion (CIMDL) is a rare consequence of cocaine insufflation that involves the nose, sinuses, and occasionally the palate. Palatal perforations compromise swallowing, mastication, and speech. An obturator prosthesis can be used to overcome these complications. In selected cases, a nasal septal button is a good alternative for the sealing of a palatal perforation, especially when surgery is not indicated, such as in cases of persistent cocaine abuse. Abstinence from cocaine is the most effective long-term management option for patients with a CIMDL, and surgical correction of the defect should be postponed until the patient stops sniffing cocaine and the lesion becomes stable. We describe the case of a 39-year-old cocaine abuser whose oronasal communication was plugged with a nasal septal button, which resulted in an immediate alleviation of his oronasal reflux.

Rhino-orbital mucormycosis with palatal involvement in a child with type 1 diabetes mellitus

Abstract Mucormycosis is an acute life-threatening fungal infection in immunocompromised children. Very few case reports of rhino-orbital mucormycosis have been documented in pediatric age group. We report a case of rhino-orbital mucormycosis with palatal perforation in a child with type 1 diabetes mellitus that was managed with lipid complex amphotericin B coupled with surgical debridement. Early recognition and aggressive treatment have reduced the mortality and morbidity.

A case of hard palate perforation

Tuberculosis (TB) is a major public health problem in developing countries. Lung is most common affected organ, however extra pulmonary tuberculosis (EPTB) is also not uncommon. The clinical manifestations of EPTB may be non-specific that mimics other diseases and is usually misdiagnosed. Therefore, high clinical suspicion of EPTB infection is important, especially in endemic areas. Here, we present a case of hard palate perforation that proved to be tuberculous in origin. The diagnosis was made by histo-pathological examination and positive TB Polymerase chain reaction (PCR).

Ectodermal Dysplasia with Spontaneous Palatal Perforation: Case Report of a Rare Occurance

Ectodermal Dysplasia with Spontaneous Palatal Perforation: Case Report of a Rare Occurance

Oral Manifestation of NK/T-Cell Non-Hodgkin Lymphoma Mimicking Mucositis: Challenges in Diagnosis and Management

Involvement of the oral cavity in extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT) is uncommon and often presents as a palatal perforation. A 37-year-old male with ENKTCL-NT accompanied by palatal perforation was referred to our dental oncology service for evaluation of oral lesions at 1 month after radiation and chemotherapy. Intraoral examination revealed painful ulcers and pseudomembranes on the upper lip, bilateral buccal mucosa, and lateral border of the tongue. The main working diagnosis was oral mucositis. Treatment with low-level laser therapy, together with topical anesthetics and anti-inflammatory agents, produced no response. An incisional tongue biopsy was performed, and the results were consistent with a diagnosis of NK/T-cell lymphoma involvement. The patient presented a rapidly worsening clinical status and was admitted to the intensive care unit. This case underscores the aggressive behavior of this lymphoma and the atypical forms in which it can present.

Clinical Pathologic Conference Case 2: Palatal Perforation

Clinical Pathologic Conference Case 2: Palatal Perforation

Une cause de nécrose palatine à ne pas méconnaître

We report a case of pseudotumoral nasal septum and hard palate perforation in a 42-years-old man. The diagnosis retained after differential diagnosis exclusion was necrotic midfacial lesion due to chronic inhalation of cocaine. This condition can mimic vasculitis, primary tumors and granulomatous infections. Differential diagnosis and pathophysiology of this condition will be discussed in this anatomo-clinical case.

Prosthetic Management for a Palatal Perforation from Cocaine Abuse.

The intranasal inhalation of cocaine predisposes the user to a wider range of local and systemic complications. This article describes the history of a 31-year-old woman with a palatal perforation produced by the chronic use of cocaine. In view of the doubts about abstinence from cocaine abuse, prosthetic management was chosen. The obturator comprised a metal framework for dental retention and to prevent displacement and a resin obturator to block the defect. In addition, acrylic resin facilitated adjustments due to the fact that it is easy to adapt to changes in the size of the palatal defect.

An adult case of unexplained soft palate perforation

An adult case of unexplained soft palate perforation

Prosthetic management of palatal perforation in heroin abuse patient

Prosthetic management of palatal perforation in heroin abuse patient

Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications.

The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid-acetaminophen abuse and outline optimal therapy. This study was a retrospective chart review. Patients with intranasal pathology from inhalation of combined opioid-acetaminophen medications (COAMs) from 3 academic otolaryngology practices in western Pennsylvania from January 2012 to October 2012 were included in the review. Seven adults ranging in age from 23 to 46 years were identified with nasal complaints from the intranasal inhalation of COAMs. All patients presented with nasal pain and were found to have fibrinous necrotic nasal mucosa involving the posterior nasal cavity and nasopharynx. Of the 7 patients, 6 (85.7%) presented with a septal perforation. Pathology and culture revealed fungus in 85.7% of the patients; however, no invasive fungal disease was noted in any of the specimens. Patients did not improve with either systemic or topical antifungal therapy. Polarizable material characteristic of talc used as a tablet binder was present in the histopathology of 4 of 7 (57.1%) patients. Patients who abstained from intranasal drug use along with serial debridement demonstrated the greatest improvement. Intranasal COAM abuse causes nasal pain, tissue necrosis with potential septal and palatal perforation, and noninvasive fungal colonization. Antifungal therapy was of no benefit in the current series of patients. Current therapy should focus on recognition of the etiology of patients' pathology and encourage abstinence from intranasal use of these drugs along with serial debridements.

Progressive midfacial bone erosion and necrosis: Case report and differential diagnosis

A 31-year-old woman presented with a large oro-nasal communication (ONC), loss of vomer and significant nasal cartilage and nose deformity. Physical examination of the patient revealed a typical midline destructive lesion (MDL) with nasal septum and hard/soft palate perforation with a friable granular surface and a large amount of necrotic tissues. Medical history was unremarkable and the patient denied previous local trauma, including surgical procedures or drug assumption.Pathological examination revealed the presence of necrosis and chronic inflammation.MDLs have numerous etiologies. Signs and symptoms of MDLs can be similar and an accurate diagnosis may be elusive.We hereby present detailed clinicopathological findings.

Cocaine induced midline destructive lesions.

Review of the literature concerning cocaine induced midline destructive lesions (CIMDL). We reviewed the English literature regarding CIMDL involving the nose and its surrounding structures. The review is based on a search of the US National Library of Medicine (PubMed) online database from January 1st, 1982 to March 31st, 2013. CIMDL is a pathology that mimics systemic diseases with positive anti-neutrophil cytoplasmic antibodies (ANCA). The prevalence of CIMDL is considered to be about 4.8% among cocaine users. Clinical manifestations include hyposmia, facial pain, crusting, ulcers, nasal septal perforation, palatal perforation, sinus wall destruction, orbital erosion and damage of the anterior skull base. The presence of ANCA directed against human neutrophil elastase (HNE) is the most distinguishing feature of CIMDL. Toxicological tests, indirect immunofluorescence microscopy, antigen specific solid assay testing, histopathological analysis, apoptosis assay and MRI imaging concur in the clinical identification of CIMDL. The pathogenesis of CIMDL is poorly understood and implicates inflammatory, infective, proapoptotic and autoimmune mechanisms. CIMDL must be readily recognized by clinicians to provide appropriate treatment. Immunosuppressive therapy has no role in the treatment of CIMDL. Only abstinence can interrupt the progression of the disease.

Lepromatous Leprosy with Palatal Perforation : A Rare Presentation

Lepromatous leprosy is a multisystem disease that develops in individuals with decreased cell mediated immune response against mycobacterium leprae. Lepromatous leprosy with palatal perforation is a rare presentation and if the patient is left untreated, it causes massive multiplication of Mycobacteria leprae that infiltrate the skin, nerves, eyes, upper respiratory tract, reticuloendothelial system, testes, adrenals, oral cavity and other viscera. We hereby report this case in a female suffering from lepromatous leprosy with complications of palatal perforation and lost central incisor teeth simultaneously.

Infliximab for refractory oral ulcers

Recurrent oral ulcer (ROU) is a common condition that significantly impacts quality of life. It is often related to systemic diseases, such as Behçet's disease (BD), Crohn's disease, and ulcerative colitis. Treatment of ROU depends on its severity: from topical agents for mild cases to systemic agents, such as corticosteroids, azathioprine, or other immunosuppressants for severe cases. Recently, good results have been reported with infliximab in refractory ROU. However, the optimal dosage and treatment duration have not been determined and the cost and potential side effects should be considered. We report on four patients who received a single-dose infliximab for refractory ROU. Two patients had refractory ROU with no underlying disease; one of them had soft palate perforation accompanied by severe oral ulcers. The two other patients had ROU of BD without major organ involvement. All patients received a single infusion of infliximab and an additional infusion was given on demand in one patient. Infliximab showed a rapid, good response in three patients and was also effective in improving the acute inflammation in the perforation of the soft palate, which had been resistant to conventional therapies. These effects diminished over a few weeks, but the ROU were tolerable and it was not necessary to increase steroids or add another medicine for about 1year. We suggest that a single infusion of infliximab can be considered for refractory ROU.

Cocaine induced midline destructive lesions

Review of the literature concerning cocaine induced midline destructive lesions (CIMDL). We reviewed the English literature regarding CIMDL involving the nose and its surrounding structures. The review is based on a search of the US National Library of Medicine (PubMed) online database from January 1st, 1982 to March 31st, 2013. CIMDL is a pathology that mimics systemic diseases with positive anti-neutrophil cytoplasmic antibodies (ANCA). The prevalence of CIMDL is considered to be about 4.8% among cocaine users. Clinical manifestations include hyposmia, facial pain, crusting, ulcers, nasal septal perforation, palatal perforation, sinus wall destruction, orbital erosion and damage of the anterior skull base. The presence of ANCA directed against human neutrophil elastase (HNE) is the most distinguishing feature of CIMDL. Toxicological tests, indirect immunofluorescence microscopy, antigen specific solid assay testing, histopathological analysis, apoptosis assay and MRI imaging concur in the clinical identification of CIMDL. The pathogenesis of CIMDL is poorly understood and implicates inflammatory, infective, proapoptotic and autoimmune mechanisms. CIMDL must be readily recognized by clinicians to provide appropriate treatment. Immunosuppressive therapy has no role in the treatment of CIMDL. Only abstinence can interrupt the progression of the disease.

Palatal perforation with McGrath Series 5 videolaryngoscope

To the Editor: A healthy pregnant patient (height 166 cm, weight 80 kg) who had an adequate preoperative fasting period was taken into the operating room to undergo an elective cesarean section. Induction of anesthesia was provided with thiopental sodium 5 mg/kg intravenously (IV) and rocuronium bromide 0.6 mg/kg IV. Direct laryngoscopy using a Macintosh 3 blade provided a Cormack–Lehane (CL) grade 3 glottic view. Tracheal intubation failed even when the head and neck were repositioned. A McGrath Series 5 videolaryngoscope (MGS-5; Aircraft Medical Limited, Edinburgh, UK) was used to see the glottis. However, no view was obtained from the first attempt. Nevertheless, intubation was successful during the second attempt, under a CL 2 view, with a styletted 7.5-mm endotracheal tube bent 60 upward just proximal to the cuff according to the angle of the blade. The tip of stylet did not protrude beyond the tube. After removing the MGS-5 from the mouth, blood was seen on the back side of the blade. A direct view of the oral cavity revealed bleeding on the right side of the soft palate. Perforation of the right palate was found, which was repaired by an otorhinolaryngologist during the cesarean section (Supplementary Fig. 1). The patient recovered completely. The exact cause why the tube or the blade of MGS-5 caused right palate perforation was not clearly identified. The MGS-5 is a portable device that provides a better glottic view compared to conventional laryngoscopy and is an alternative to difficult or failed direct laryngoscopy [1, 2]. Besides the existence of palatal injuries using a GlideScope videolaryngoscope, there has been only one case report indicating palatal perforation associated with MGS-5. In their report, the authors concluded that injury occured during tube placement within the blind period of intubation process [1]. This case demonstrates that keeping direct visual contact with the blade of MGS-5 and the tip of tube while inserting it into the oral cavity may minimize the risk of palatal injury.

Traumatic Palatal Perforation after Orotracheal Intubation: A Case Report and a Review of the Literature

In this report, we describe an unusual case of a traumatic palatal perforation caused by orotracheal intubation. The paucity of reports of palatal perforation resulting from intubation in the literature suggests that it is a rare occurrence. However, recognizing this potential complication and managing the airway appropriately may reduce patient morbidity.

Repair of Cocaine-Related Oronasal Fistula With Forearm Radial Free Flap

Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion. A review of the English-language literature reveals only a few articles describing the treatment of hard and/or soft palatal perforation related to cocaine inhalation. Described here are 4 patients with a history of cocaine abuse showing palatal lesions. From 2010 to 2013, a total of 4 patients affected by cocaine-related midline destructive lesions were referred to our department. They all presented signs of a cocaine-induced midline destructive lesion. They showed wide midfacial destruction involving the nasal septum as well as the hard and soft palates causing an ample oronasal communication. In 3 patients, oronasal communication has been treated successfully using a personal technique based on a partially de-epithelialized forearm free flap. The fourth patient had been treated only with local debridement because, when she came to our attention, her abusive habits were still unsolved. Different surgical options have been reported such as local, regional, and free flaps for hard and soft palate reconstruction. However, because of an unpredictable vascularization of the palatal tissues and owing to the scarceness of the local soft tissues, local flaps are at high risk for partial and complete failure. The transfer of free vascularized tissue, however, seems to be the most reliable and logical solution for medium- to large-sized fistulas. Among the various free flaps, we choose the radial forearm type because of the pedicle length and the flap thickness.