Introduction, Classification, Congenital/ Developmental- Cleft Palate, Infection/Inflammatory disease- Osteomyelitis, Syphillitic gumma, Tuberculosis, Traumatic wound, Leprosy, Noma, Mucormycosis, Trauma- fracture of maxilla, use of suction disc for denture, Iatrogenic- Maxillectomy, Drug related- due to cocaine, bisphosphonates, Rare cases- rhinoliths, Autoimmune- Lupus Erythematosus, wegeners granulomatosis, Sarcoidosis, Neoplastic- SCC,

1. PERFORATIONOF PALATE
PRESENTEDBY:
DR GAYATRI MEHROTRA

2. INTRODUCTION
• 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.

3. CLASSIFICATION
• Congenital/Developmental-
 Cleft palate
• Infection/Inflammatory Disease-
Osteomyelitis
Syphillitic gumma
Tuberculosis
Infection of traumatic and
chronic wound

4. Leprosy
Noma
Mucormycosis
Toxoplasmosis
Blastomycosis
• Autoimmune-
Lupus erythematosus
Sarcoidosis
Crohns disease
Wegener granulomatous

5. • Neoplastic-
Tumor from maxillary sinus or nasal cavity
Squamous cell carcinoma
Mucoepidermoid carcinoma
Adenocystic carcinoma
Lymphoma
Midline lethal granuloma
Melanosarcoma

6. • Trauma-
Fracture of maxilla
Use of suction disc for denture
• Drug related-
Due to cocaine abuse
Bisphosphonates

7. • Iatrogenic-
Tooth extraction
Maxillectomy
• Rare causes-
Rhinolithcan

8. CONGENITAL/DEVELOPMENTAL
• CLEFTPALATE-
 It is a birth defect characterized by an opening in
the roof of the mouth caused by a lack of tissue
development.
Cleft of hard palate and soft
palate ; sometimes
soft palate alone.

9. • Some syndromes, maternal alcohol
consumption and cigarette smoking, folic acid
deficiency, corticosteroid use and
anticonvulsant therapy are some causative
agents for this abnormality.

10. Eating and drinking are difficult due to
regurgitation of food and liquid through the nose.
Speech problem
Defect in smelling
Airway problems in some cases.
Radiograph- missing,
supernumerary,
malpositioned teeth

11. • Management :
 Cheiloplasty
 Obturator
 Palatoplasty
 Bone grafting
 Orthodontic therapy
 Cleft rhinoplasty
 Speech therapy
 Pyschotherapy

12. INFECTION/INFLAMMATORY DISEASE
• OSTEOMY ELITIS-
It is defined as an inflammatory condition of the
bone that begins as an infection of medullary
cavity and the haversian system and extends to
involve the periosteum of the affected area.
Predisposing factors- diabetes mellitus,
tuberculosis, severe anemia, leukemia,
agranulocytosis,etc

13. Etiology- odontogenic infection, infection from
pdl space , extraction wound.
Compromised blood supply is a critical factor in
the establishment of osteomyelitis.
Virulent
microorgansims
Intense
inflammatory
reaction
Localization
of infection
Disorganization
of clot
Mechanical
trauma
Accumulation
of pus
Elevation of
periosteum
Necrosis of
bone
Penetration
of
periosteum

14. • Management-
Incision and drainage
Irrigation and debridement of the necrotic area.
Antibiotics
Supportive therapy
Sequestrectomy
Saucerization
Decortication
Hyperbaric oxygen therapy

15. • SYPHILLITIC GUMMA-
Classic disease with protean manifestations.
4 main clinical stages
Gumma- tertiary syphillis
Small raised
area of
mucosa
ulcerates
Large zone of
necrosis
Denudation of
bone
Perforate into
nasal cavity

16. Common site- midline of hard palate
Painless
Appearance – solitary, deep,punched out
mucosal ulcer
Punched out ulcer with vertical walls and dull red
granulomatous base
Types- central gumma
- cortical gumma
Leutic glossitis
Chronic superficial interstitial glossitis

17. Fig. 1 Perforation of the hard palate caused by
tertiary syphilis
Fig. 2 Abnormal scarring of throat and
posterior oral cavity
70, yr old male pt, with c/o inability to eat & recent hoarseness of voice.pt
was confirmed with edentulous arches , 2 perforations of palate of the hard
palate and nasal speech…pt denied for any extramarital exposure…and was
tested positive for acute infectious syphillis…. pts wife was invited for
test…when she came to know that test was for veneral disease she left the
hospital (british dental journal 2005)

18. • Management :
Antibiotics- benzathine penicillin (2.4 million
units IM).
Allergic to penicillin- erythromycin (500 mg 4
times a day for 15 days).
Obturator for managing the palatal perforation.

19. • Tuberculosis-
Tuberculosis of hard palate is rare and usually
secondary to pulmonary TB.
Cough ,Low grade fever, loss of wt, chills, night
sweats.
Invasion of mycobacterium- break of natural
barrier- trauma, inflammatory condition,
Leukoplakia, tooth extraction, poor oral hygiene,
dental abscess, periodontitis.
Common site - tongue

21. Manifest as single, non-healing ulcers with an
indurated, irregular, undermined margin, and a
necrotic base.
The palatal lesion of TB may be seen as
granulomas, ulceration, or perforation.
Usually seen in patients with strong immune
response and due to hypersensitiviy to acid fast
bacilli.

22. Oral cavity examination showing
perforation of the hard palate, 3 × 3
cm in size with an irregular,
undermined margin, and a necrotic
base
Plain axial computed tomography scan
of midface with 3D reconstruction
showing erosion and scalloping of the
posterior part of the hard palate on the
right side
7 yr old boy with difficulty in swallowing solid foods,low grade
fever and loss of wt, wt was 13 kg and ht was 104 cm…perforation
of hard palate was seen…chest xray showed homogenous opacity
in upper rite lung …bilateral cervical lymphadenopathy was
present.(Dental research journal 2012)

23. • Management:
Timing Medications
Months 1 and 2 INH, RIF, PZA,EMB
Next 4 to 7 months
depending on
condition
INH, RIF
EMB= ethambutol;
INH=isoniazid;
PZA=pyrazinamide;
RIF=rifampin

24. • INFECTIONOF TRAUMATIC WOUND-
Traumatic lesions in the oral cavity occur
frequently in clinical practice.
 Most of the acute or chronic injuries of soft
tissues were aroused from incorrect hygienic
procedures or iatrogenic injuries.
 Trauma is known to be one of the rarest causes
leading to palatal perforation.

25. Figure 1: Perforation of the hard palate Figure 2: Closure of the palatal perforation.
A 28-year-old male farmer reported to clinics with hole in
the hard palate since 3 months. Patient had difficulty while
eating and hoarseness of voice and change in speech. The
patient revealed that, the perforation was resulted
secondary to the injury led by a horn of a calf while working
in his fields. ( journal trauma and treatment 2012)

26. • LEPROSY-
Hansen’s disease usually presents as anaesthetic
or hypoaesthetic skin lesions, tingling numbness
with or without weakness of hand or feet.
Major target organs- skin,peripheral nerves,
nasal mucosa, upper respiratory tract,eyes.
2 types- tuberculoid and lepromatous

27.  Various types of lesions observed are infiltration,
ulceration, perforation, reddish or yellow reddish
nodules, sessile or pedunculated, varying from 2
to 10 mm, some confluent and prone to
ulceration .

28. As palate is a structure crossed by two air
currents, the nasal and the oral , its temperature
remains 1-2° c below the body temperature-
explains location of palatal lesions in midline.
Oral lesions are aymptomatic and secondary to
nasal changes.
Gums are usually affected behind the upper
central incisors, often by contiguity of lesions of
the hard palate

29. 35 yr old female pt with h/o
multiple red raised skin lesions
over upper limb, lower
limb,trunk, back and face of 1 yr
and hole in hard palate of 4
months duration (Eygyptian
dematology journal 2014)

30. h/o lost upper central incisor with no h/o
trauma..skin biopsy showed lepromatous leprosy

31. A patient with a history of leprosy. Look at
depression of nasal bridge(A) and palatal
perforation(B)

32. • Management –

33. • NOMA-
Also known as cancrum oris
It is a rapidly spreading mutilating gangrenous
stomatitis.
Begins as small ulcer of gingival mucosa which
spreads and involves surrounding tissues of
jaws, lips, and cheeks by gangrenous necrosis.
Palate and occasionally tongue may become
involved in this process, but this is not common.
Last stage of ANUG.

35. • Management-
Control of dehydration and electrolyte balance
Antibiotics- drug of choice is penicillin
Reconstructive surgery

36. • Mucormycosis-
Also known as phycomycosis, zygomycosis
Infection extending from sinus mouth
lesions are ulcerative hard palate spreads
Functional impairment of cranial nerves II, III, IV,
VI are characteristic sequelae.
Ptosis,proptosis, nasal obstruction, fever, swelling
of cheek and paresthesia of face can occur.
Appearance of reddish black nasal turbinate and
septum.

37. Mucor is often recognized as a triad of
symptoms, such as uncontrolled diabetes
mellitus, periorbital infection and
meningoencephalitis.
Black nasal
septum

39. 35 yr old female pt reported
with c/o sudden exfoliation
of maxillary teeth . Maxillary
anterior teeth and premolars
were missing with necrosed
bony sockets…biopsy
showed features of
mucormycosis (JIAOMR
2010)

41. • Management-
The gold standard antifungal agent is
Amphotericin- B.
1.0-1.5 mg/kg/day dosage continued for 8-10
weeks.
Control of underlying disease
Prosthetic obturation of palatal defect
Surgical debridement of infected and necrotic
tissue

42. trauma
• FRACTURE OF MAXILLA-
Fracture of palate present a unique challenge to
the surgeon in management of mid facial
fracture.
Most often palatal fracture are associated with
other fractures of the midface.
Rarely found isolated, usually found with lefort
fracture ( usually in case of lefort II fracture)

43. 55 yr old male pt reported
with c/o intraoral drainage
from palate….the discomfort
was of a few days duration
and had its origin following
a road traffic accident which
led to Lefort II fracture.
( Journal of Medical and
Dental sciences 2014)

45. • USE OF SUCTIONDISC FOR DENTURE-
Construction of complete dentures with
adequate retention is a complex procedure.
For the past several years suction cups are used
to get retention and stability of the compete
dentures.
But today they are not recommended one
because of their destructive effects.

46. 65 yr old male pt with
c/o hole in upper jaw,
presence of nasal twang
in voice ,loose fitting
denture. H/o denture
since 20 yrs & defect was
present since 1 yr.
(Journal of Clinical and
Diagnostic Research
2013)

48. • Management-
Educating the patient about the ill effects of
continuous use of suction cup denture.
 The closure of palatal perforation is primarily by
surgical means.
These options are local advancement flaps viz.
palatal flaps or tongue flap, distant pedicle flaps
like buccal fat pad,temporoparietal fascial flap.

49. IATROGENIC
• Maxillectomy-
Maxillofacial orthopedic surgery is a safe,
predictable and stable procedure.
 The number of life-threatening complications
associated with this surgery appears to be very
small.
Usually, these complications are related to the
degree of vascular compromise and occur in
fewer than 1% of cases

50. Rupturing
of the
descending
palatine
artery(DPA)
during
surgery
Postoperative
vascular
thrombosis
Perforation
of palatal
mucosa
when
splitting the
maxilla into
segments
Partial
stripping of
palatal soft
tissues to
increase
maxillary
expansion
Impair blood supply
to the maxillary
segments

51. Pt reported after
maxillectomy and
radiotherapy (JSM
Dentistry 2014)

52. Case of maxillary aseptic necrosis
which was reported after lefort I
osteotomy which was then
treated with hyperbaric oxygen
therapy and antibiotics.
(Journal of Oral and Maxillofacial
Surgery 2010)

53. Drug related
• Due to cocaine abuse-
Cocaine is an alkaloid extract derived from the
Erythroxylon coca plant.
Nowadays the most common route of
administration is snorting.
Smoking has increased in popularity with the
advent of ‘crack’ cocaine.
Also abused intravenously.

54. Local complications of intranasal cocaine abuse
include chronic rhinitis, sinusitis, epistaxis,
ossification or necrosis of the nasal septum, and
in rare cases, palatal perforation.
Use of cocaine, a potent vasoconstrictor, can lead
to ischemia, necrosis, and ulceration.

55. A healthy 25-year-old man
presented to the surgical
clinic with a hole in the
roof of his mouth that
allowed nasal
regurgitation of food
when he ate. The hole had
been present for a year,
and he requested surgical
correction. The patient
reported a 5-year history
of nasal cocaine use from
which he had recently
abstained. (New England
Journal of medicine 2007)

56. The estimated incidence of complications
associated with cocaine abuse is 4.8%.
Oronasal palatine perforations are among the
most extreme and rarely published side effects.
The diagnosis of such lesions is based on the
patient clinical history, including antecedents of
sustained cocaine abuse.
50 yr old female with
paranasal necrosis and
perforation in hard palate as
well as soft palate.( 1cm +3
cm )
( J Clin Exp Dent 2010)

57. A 29 yr old male patient with a painless
lesion measuring 2cm in diameter, located
in hard palate and affecting the midline
and presence of pionidal abscess (J Clin
Exp Dent. 2010)

58. • Management-
Sealing of the defect either surgically or with an
obturator.
Patient rehabilitation as regards cocaine abuse.
The surgical technique is chosen according to the
location and dimension of the lesion, the daily
dose and duration of cocaine addiction.

59. • BISPHOSPHONATES-
Bisphosphonates (BPs) are a class of drugs
derived from pyrophosphates, endogenous
inorganic regulators of mineralization, by
substituting the oxygen atom in the basic
pyrophosphate chain with a carbon; this leads to
osteoclast inhibition, decreasing bone resorption

62. A 63 year old man presented with the complaint of an air leak through his
mouth to his nose… had renal cell carcinoma…pt was on sunitinib and monthly
pamidronate…exposed necrotic bone in the central-posterior part of the hard
palate…diagnosed as osteonecrosis with a secondary oro-nasal
fistula…..The patient was treated with antiseptic irrigation, conservative
debridement, and antibiotics; the pamidronate and sunitinib treatments were
discontinued (IMAJ 2012)

63. Rare causes
• Rhinolithcan-
Rhinoliths are calcareous concretions occuring in
the nasal cavity.
Rhinolithiasis is a disease caused by deposition of
organic and inorganic compounds in the nasal
cavity, leading to unilateral nasal obstruction,
fetid rhinorrhea,epistaxis, and it may cause
complications.

64. Rhinolithiasis is an uncommon disease that may
present asymptomatically, characterized by presence
of mineralized tumor in the nasal cavity, which may
be large and deviate neighboring structures
The presence of deviation and nasal septum
perforation, destruction of nasal cavity lateral wall,
involvement of maxillary sinus and production of
oroantral or oronasal fistula are rare complications.
Pinto et al reported a case of rhinolith in a 54 yr old
woman causing palatal perforation.

65. Female 43-year-old
patient, reported
progressive nasal
obstruction only on left
nasal fossa…. 6 months
before she had
perforation of palate with
drainage of nasal
secretion into the oral
cavity and regurgitation of
fluids into the left nasal
cavity.
pt reported that at the
age of 2 yrs she
introduced a bean seed
into the left nostril which
was removed the next day
and she had remained
without complaints

67. • Management –
Treatment consists of removal of rhinolith and
the surgical approach chosen depends on
location and size of the rhinolith and presence or
not of complications, but most of them may be
removed endonasally.
External approaches may be necessary in cases of
giant rhinoliths, and endoscopes are extremely
helpful in both approaches.

68. Autoimmune disorders
• Lupus erythematosus –
2 types- discoid lupus erythematosus
systemic lupus erythematosus
Patients develop antibodies to many of their own
cells.
Carpet track extension
Butterfly distribution

69. In systemic, skin lesions are widespread, bilateral
with signs of acute inflammation.
Kidney and heart involvement in case of systemic
lupus erythematosus.
Oral manifestation- common site is buccal
mucosa , tongue and palate
14 yr old girl with systemic
lupus erythematosus has
diffuse erythema of hard and
soft palate associated with
scattered vesicles, papules

70. Begins as erythematous area slighly elevated,
typically with white spots with superficial painful
ulceration.
Lupus chelitis- lip lesion with central atrophic
area with small dots surrounded by keratinized
border.
Lesions on palate progress to perforation in very
aggressive cases and is very rarely found.

71. • Management –
Coticosteroids- systemic and topical application
also.
Anti-malarial drugs like hydroxychloroquine
combined with NSAID is also effective treatment
modality.
Avoid exposure to sunlight as it can aggravate the
condition.

72. • Wegeners granulomatosis-
It is a granulomatous involvement of blood
vessels resulting in necrosis of tissue.
3 types- generalized or classic
localized or limited
superficial
 common symptom- nasal
stuffiness with chronic
discharge which is
sometimes bloody
Rhinitis, sinusitis, otitis

73. Oral lesion typically include ulceration of the
palate by extension of nose lesion and
destruction of nasal septum
 leading to perforation of palate
Loosening of teeth
Strawberry gingivitis
Ulceration can occur on any surface which is
perforating in nature.
Cranial nerve palsy, oroantral fistulae, parotid
swelling

74. Strawberry gingivitis

75. A 26 yr old female pt….had an 18 month history of nasal
discharge and nasal stiffness..examination revealed saddle
nose deformity with destruction of nasal septum as well as
palate ..pt was positive for classic antineutrophil cytoplasmic
antibody (cANCA)

76. • Management-
Cotrimoxazole- combination of trimethoprim and
sulfamethoxazole
Corticosteroids- regimen of cyclophosphamide 12
mg/kg body wt/day with prednisolone 1mg/kg
body wt

77. • SARCOIDOSIS-
Multisystem granulomatous disease.
Impaired cell mediated immunity
Most common in lungs,skin,lymph nodes,salivary
glands, spleen and bones
Bilateral hilar lyphadenopathy
Oral features- rare in oral cavity
Enlargement of salivary
gland- causing xerostomia
Small papular nodules on lip

78. On palate and buccal mucosa- bleb like
containing a clear yellowish fluid or as solid
nodules.
Figure 1. Patient 4: clinical presentation
of oral sarcoidosis showing a whitish
lesion involving the left side of inferior
part of the tongue. Figure 2. Patient 2: clinical
presentation of oral sarcoidosis of the
hard palate showing multiple nodules
with a whitish central base.

79. • Management –
Corticosteroids- only in symptomatic cases
Asymptomatic- lesion resolves within 2 yrs of
duration
Doxycycline, hydrochloroquine,methotrexate
are the other drugs used.

80. • Crohns disease-
It is an inflammatory disease involving entire wall
of a portion of small duct.
Oral manifestation-
Buccal mucosa- cobblestone appearance
Vestibule – linear and hyperplastic folds which
mimic denture induced hyperplasia
Lips- swollen and indurated
Palate- multiple ulcers
Gingiva and alveolar mucosa- granular
erythematous swelling

82. • Management –
Patient can respond to sulfasalazine
Corticosteroids like prednisolone can be used
with azathioprine
Oral lesions are treated with topical and
intralesional corticosteroids.

83. neoplastic
Prevalence of malignant
neoplasms

84. • Squamous cell carcinoma-
Tobacco particularly cigarettes and alcohol
remains the primary factor in the etiology of
squamous cell carcinoma.

85. Carcinoma of palate is common in pts with habit
of reverse smoking.
Palatal cancer usually manifests as a poorly
defined ulcerated painful lesion on one side of
the midline.
Most of the lesions are exophytic and with broad
base and nodular surface.
Tumor of hard palate may
invade the bone or
occasionally the nasal cavity.

87. • CARCINOMA OF MAXILLARY SINUS-
It is an uncommon malignancy of largely
unknown cause.
Among the paranasal sinus carcinoma, the
maxillary sinus is the most common site.
Affected pt generally complain of a chronic
unilateral nasal stuffines or notice an ulceration
or mass of the hard palate or alveolar bone.
If extension is medial, then nasal obstruction or
hemorrhage occurs.

88. • Involvement of floor of sinus leads to expansion
of the alveolus, unexplained pain , numbness of
teeth, loosening of teeth and swelling of palate
leading to penetrating the oral cavity.

89. • NECROTIZING SIALOMETAPLASIA-
It is an uncommon, locally destructive
inflammatory condition of the salivary glands.
It is the result of ischemia of the salivary tissue
that leads to local infarction.
Hard palate is affected more often than the soft
palate.
2/3 cases are unilateral
Common in adults- mean age = 46 yrs

90. • Initially as a non-ulcerated swelling often
associated with pain or paresthesia
• Within 2-3 weeks, necrotic tissue sloughs out
leaving a crater like ulcer
• Patient may report that “ a part of my palate fell
out”
• At this point, pain often subsides.
• Rare instances, destruction of underlying palatal
bone.

92. 40 yr old male pt who was a driver by occupation reported with c/o pain in palatal
region since 14 days..h/o pus discharge..no h/o trauma, fever or paresthesia with h/o
extraction of upper front teeth…I/O examination revealed swelling in hard palate
extending posteriorly from palatal mucosa behind anterior teeth upto junction of
hard and soft palate ..there was palatal perforation in mid palatal region…P/D of CGP
with suppurative osteomyelitits was made ..biopsy was done which gave final
diagnosis of necrotising sialometaplasia ( JIAOMR 2014)

94. • CARCINOMA EX PLEOMORPHIC ADENOMA-
It represents a malignant transformation within
what was previously a benign neoplasm.
Mean age of pts with this tumor is about 15 yrs
older than that for the benign pleomorphic
adenoma.
Primarily associated
with parotid gland.
Produce facial nerve
palsy.

95. • MUCOEPIDERMOID CARCINOMA-
60 % occur in parotid and 30% in the minor
salivary glands, especially those of palate.
Slow enlarging painless mass.
Pain and facial nerve palsy.
Lacrimation, trismus, nasal discharge, and blood
tinged saliva.
Tumor of high grade malignancy tends to
infiltrate the surrounding tissues.

96. • ADENOCARCINOMA-
Adenocarcinoma of the salivary glands are rare
but aggressive tumors.
Polymorphous low grade adenocarcinoma is an
indolent malignancy developed almost
exclusively in minor salivary glands.
Manifests as asymptomatic slow growing mass
in the oral cavity.
 High density of glandular tissues in the palate
and in particular the junction of hard and soft
palates renders this location the most frequent
site for minor salivary gland neoplasms

97. A 76 yr old lady
presented for
evaluation of an
asymptomatic growth
in the roof of her mouth
gradually increasing
over the past yr and
interfering with the
seating of her upper
complete denture
( Archives of orofacial
sciences 2012)

98. • ADENOID CYSTIC CARCINOMA-
It is an epithelial malignant neoplasm of salivary
glands.
ACC is the second most common malignant
neoplasm of salivary gland next only to
mucoepidermoid carcinoma
Approximately 31% of lesions affect minor
salivary glands, particularly the palate.
Typical clinical findings include slow growth, local
recurrence, perineural invasion and distant
metastasis

99. 38 yr old female..with c/o swelling in
upper back jaw region for past 6
mths..had difficulty in mastication and
deglutition..swelling obliterated the
nasolabial fold…swelling extended
from 24 to 28 which was crossing the
midline and filled the palatal
vault…..incisional biopsy confirmed the
diagnosis of adenoid cystic carcinoma
(JIADS 2010)

100. • MIDLINE LETHAL CARCINOMA-
Described as idiopathic progressive destruction
of nose, palate, face and pharynx.
It is due to a dysfunction of the immune
mechanism normally responsible for granuloma
formation.
Begins as superficial ulceration of the palate or
nasal septum.
Eventually ulceration spreads from palate to
inside of nose.

101. • Palatal, nasal and malar bones may become
involved.
• Loss of entire palate is common.
• Destructive lesion in the midline of palate will
diagnose this condition.

103. 21 yr old male pt..with 2 month h/o pain and foul smelling discharge from his hard
palate..asociated with low grade fever, chills and sweating along with regurgitation
of food and fluid through nostrils…with possibility of bacterial osteomyelitis , pt was
started on iv clindamycin but did not work…then voriconazole was given due to
possibility of fungal infection..immunophenotyping of the biopsy revealed focal
zones of neoplastic lynphocytic infiltrate involving minor salivary glands ..thus
giving diagnosis of T cell lymphoma (BMJ CASE REPORT 2011)

104. • MELANOCARCINOMA-
Melanoma is the malignant neoplasm of
melanocytic origin.
Common oral site of occurrence- palate and
maxillary gingiva
Oral lesion typically begins as a brown to black
macule with irregular borders.
Ulceration may develop early
Pain is not a common feature

106. • Management-
Surgery
Radiation therapy
chemotherapy

107. CONCLUSION

108. refernces
• Palatal Perforation: Causes And Features
• Unusual Traumatic Injury Causing Hard Palate
Perforation J Trauma Treat Volume 1 Issue 4
• Palatal Perforations: Past And Present. Two Case
Reports And A Literature Review British Dental
Journal Volume 199 No. 5 Sept 10 2005 267
• Suction Cup Induced Oronasal Communication JIADS
VOL -1 Issue 3 July - September,2010
• Surgical And Prosthetic Management of Suction Cup
Induced Palatal Perforation: Case Report Journal of
Clinical and Diagnostic Research. 2013 Sept, Vol-7(9)

109. • Oral Involvement In Sarcoidosis: Report Of 12
Cases
• Rhinolithiasis As Cause Of Oronasal Fistula
• Palatal Perforation: A Rare Presenting Sign Of
Leprosy
• Palatal polymorphous low grade
adenocarcinoma: case report and review of
diagnostic challenges.
• Adenoid Cystic Carcinoma of Palate – A Case
report with Review of Literature.
• Bisphosphonate and nonbisphosphonate
associated osteonecrosis of the jaw- A review

110. QUESTIONS
• Causes of perforation of palate?
• Management of perforation of palate?
• Difference between perforation due to syphillis
and osteomyelitis?

111. • Most common tumor which causes perforation
of palate?
• Complications of palatal perforation seen?