Reconstruction of the palate is a challenging endeavor. As with any defect, thinking about the goals of reconstruction from both a functional and esthetic point of view will help decide which approach is most suitable for the patient. Soft tissue defects of the hardpalate are essentially a nonissue, as the hardpalate can be left to granulate. Bony defects in a dentate patient can be treated conservatively with an obturator. Bony defects of the upper alveolar ridge will cause a significant cosmetic and functional deformity, and therefore free tissue transfer techniques will augment the anterior projection of the face and the soft tissue can be used to seal the oral cavity from the nose. Each technique has its advantages and disadvantages. The goal of maintaining speech, swallowing and anterior facial projection should be kept at the forefront of each surgeon’s mind when approaching these difficult cases. 22
A history of occupational or environmental exposure to heavy metals and clinical signs of metal toxicity help to identify pigmentations of the oral mucosa. Heavy metals such as bismuth, lead, copper, arsenic, gold, cop- per, cobalt, chromium, silver, mercury, and magnesium can induce the development of a bluish-black line, the so-called Burton’s line, along the gingival margin, the thickness of which is proportional to the extent of gin- gival inflammation . In some cases, however, the hardpalate mucosa adjacent to amalgam dental fillings de- velops blue–grey macules, termed the “amalgam tattoo.” Histologically, the amalgam tattoo presents as discrete dark granules or fragments, usually surrounding collagen bundles and blood vessels, associated with low-level infil- trations of inflammatory cells . The aetiology of medication-associated oral pigmentation may be related to the use of drugs that induce melanin formation. These include clofazimine used to treat leprosy, anti-malarials such as quinine, and immunomodulatory agents. In pa- tients on hormonal therapy, conjugated oestrogens can lower the serum cortisol concentration by stimulating
Methods : A clinical study of 12 cases of pleomorphic adenoma of hardpalate operated between January 2014 to March 2018 were included in the study. FNAC was done preoperatively in all cases and coronal CT scan was obtained to rule out bony erosions. All patients had a palatal splint fabricated before surgery to help in retention of dressing and prevent food lodgement into the surgical wound during the healing phase. Wide local excision was done in all cases.
case, including rapid progression of the lesion, color, ir- regular contours, and tendency towards nodule formation. Although Kaposi´s Sarcoma is common in hardpalate it was not considered in our diagnostic hypothesis. The al- gorithm proposed by Kauzman et al. (2004)  to guide the assessment of pigmented lesions of the oral cavity on the basis of history, clinical examination and laboratory investigations includes Kaposi´s Sarcoma in the group of diffuse and bilateral pigmentation with predominantly
The mechanism in which this pigmentation is induced is as yet unknown. Recent studies in rats have implicated pigmented dimerization products of retigabine in produ- cing the discolouration . The histopathological fea- tures reported in a biopsy sample of dyspigemtend mucosa of the hardpalate by Shkolnik, showed normal epithelium without any melanin pigmentation . How- ever, melanin was evident in the submucosal macrophages and extracellular matrix. Further testing to isolate the drug in the mucosal sample using nuclear magnetic resonance and mass spectrometry were unable to identify the pres- ence of retigabine directly within the specimen. The group propose a “Tyndall effect” to explain the appearance of the pigmented mucosa. The blue clinical appearance of melanin is explained as a result of short wavelength blue light being scattered the most when compared to other wavelengths.
Fanconi Anemia is a rare autosomal recessive disorder characterized by various congenital malformations, progressive bone marrow failure at a very young age and of solid tumors development. The authors present a rare case of a squamous cell carcinoma of the hardpalate in a Fanconi Anaemia patient. The atypical clinical manifestation rendered the diagnosis more difficult. This case, for age of appearance, sex and localization, is unique in international literature. We recommend a quarterly follow up of the oral-rhino-pharynx complex in FA patients and to consider as carcinomas, all oral lesions that last more than two weeks.
Background: Analysis of the bones and bone fragments of the cranium may be a useful tool for sex diagnosis in the identification of human remains which have been exposed to adverse conditions. The object of the present study was to evaluate sex prediction through metric and non-metric analysis of the hardpalate (HP) and the pyriform aperture (PA), using macerated skulls of adult individuals. Materials and methods: We analysed 312 dry skulls of adult individuals of both sexes, studying the metric and non-metric characteristics of the HP and PA. The accuracy, sensitivity, specificity and positive and negative predictive values were evaluated. A binary logistic regression and a linear regression were performed. The receiver operating characteristic curve was constructed to analyse the perfor- mance of sex diagnosis. Measurements of the HP and the PA were analysed by ANOVA and Tukey’s test. The SPSS v. 20.0 software was used, with a significance threshold of 5%.
defect, with at least one clasp in between these two extreme points (6). The preparation of guide planes to produce one single path of insertion can also aid in retention (7). If the abutment teeth have good bony support and no signs of active periodontitis, a cast clasp and rest seat can be prescribed to augment retention and support for the prosthesis (Figure 2b). For Aramany Class IV defects, retention can be maximised by placing retentive clasp arms on the remaining premolar and molar teeth, if they are periodontally sound and have adequate root support (8). For Class Aramany II defects, clasps can be prescribed for the anterior and posterior teeth (7). If the teeth have a guarded long term prognosis, wrought gold or stainless steel clasps should be used to minimise torqueing forces on the abutments (Figure 2a). Retention can also be obtained from the defect itself. Naturally occurring undercuts within the residual hard/soft palate can be engaged by the prosthesis to augment retention. Extension of the obturator into the area superior to the lateral scar band, created by the use of a split skin graft at the time of surgery, provides an ideal undercut to aid retention of the appliance (Figure 3). Extension of the obturator onto the nasopharyngeal surface of the soft palate will also improve retention (9). Therefore at the surgical planning stage, it is imperative that the surgeon tries to preserve as much palatal tissue as possible, without compromising resection of the tumour. Patient satisfaction with an obturator will significantly decrease if more than one quarter of the hardpalate or one third of the soft palate is resected (10).
A 41 year-old female presented with a one year history of painful ulcer in her hardpalate. Physical exam revealed a 2 cm ulcerated crater located in her left palate at the junction between her hard and soft palates with mini- mal surrounding induration, and a firm, enlarged left cervical lymph node. The patient did not have any other significant comorbidities or con- stitutional manifestations. There was no clini- cal or imaging evidence of distant metastasis. No significant bone erosion was demonstrated by computer assisted tomography (CT) (Figure 1A). Magnetic resonance imaging (MRI) identi- fied a 1.8 × 1.7 × 1.8 cm mildly enhanced cen- trally ulcerative lesion at the left posterior aspect of her hardpalate with minimal sur- rounding edema (Figure 1B, 1C). The lesion extended laterally to the maxillary buttress and immediately adjacent to what appeared to be inflammatory changes of the mucosa of the left maxillary sinus. Posterior edge of the lesion extended to the greater palate foramina but there was no convincing imaging evidence of perineural spread proximal to that location. A pathologically enlarged left level IIa lymph node, 2.4 × 1.5 cm, and an enlarged right level IIa lymph node, 1.8 cm, were identified. There were prominent but not significant (by MRI size criteria) lymph nodes at left level Ib and bilat-
Figure 4: (a) Low-magnification view of the soft tissue chondroma located in the subepitelial hardpalate. It shows a multilobular pattern with large blue areas, constituted of cartilaginous tissue, surrounded by a densely sclerotic fibrous tissue. No signs of ulceration are present. Haematoxilin-eosin, original magnification ×2, bar is 1 mm. (b) The cartilaginous cells are immersed in an extremely abundant matrix and sometimes are binucleated (arrow). Haematoxilin-eosin, original magnification ×20, bar is 100 𝜇m. (c) Focally, this lesion is constituted of smaller elements characterised by either oval or reniform nucleus and a slightly eosinophilic cytoplasm. Haematoxilin-eosin, original magnification ×20, bar is 100 𝜇m.
alveolar border, along with 4 intact maxillary posterior teeth. Specimen also included a part of hardpalate, soft palate and zygoma. The maxillary sinus showed multiple polypoid masses together measuring 3 × 2.5 × 2 cm in size. Cut surface of the polyps was gray white, solid with hemorrhagic areas. Histopathological findings were same as that of incisional biopsy. Adjuvant radiotherapy was planned for the patient after the final histopathological diagnosis. External beam radiotherapy was given to the patient for 1½ months. No local recurrence of the lesion has been observed 6 months after the treatment. After 6 months X-ray chest was repeated and it revealed no pleural or parenchymal abnormalities.
According to what has been discussed, Sebawiye’s description of the “Raa” being tense with air flow, is be- cause of the beats the hardpalate receives from the tip of the tongue. Such beats were quick to the extent that they didn’t obstruct air; therefore, they can never be regarded tesnse since this tensity is different from others. Tensity dictates complete obstruction of the air and it is the same with the tense phonemes (Hamza, Jeem, dal, q, tt, ba, k, and ta). Al- Marashi (2008) said: “the sound of the alphabet with its air flow is either completely obstructed producing strong puff of air, as the case in tense phonemes, or is never obstructed so the air flows freely as in lax phonemes (2), p. 67. As for the “Raa”, the obstruction is never complete and the minor explosions resulting from the tip of the tongue touching the gum never produces resonance except through its intermit- tent quick beats which are close to air filtration process that narrows its escape.
The crowns of the teeth were coated with enamel, and the roots were coated with cementum. Root portions were not observed on the incisors. Dentin was observed below the cementum and enamel. Surrounding the den- tin was a pulp cavity that was filled with a loose connective tissue known as dental pulp (Figure 2[A]). The hardpalate consisted of non-keratinized stratified squamous epithelium, and the connective tissue was dense and unmodeled. We observed a muscle layer, palatine glands, and periosteum (Figure 2[B]). The soft palate also consisted of a non-keratinized stratified squamous epithelium, and striated skeletal muscle. Mucous glands were also present. The salivary glands contained mucosal lobes that contained serous and mucous cells. The secretory endings formed a duct system, and the intercalated ducts were composed of cuboidal epithelial cells. Several of these ducts formed striated ducts that converged into larger ducts to form excretory ducts, which consisted of an initial region composed of stratified cuboidal epithelium and a more distal region composed of stratified colum- nar epithelium (Figure 2[C]).
A 56-year-old woman noticed ulcerations on the buccal mucosa and tongue from around 2011. Although her tongue, upper and lower lip, and mucous membrane lesions were biopsied four times, no specific findings were found, so she was referred to our department in 2015. Upon an initial diagnosis as lichen planus, she had been administered with conservative oral drugs such as predni- solone, etretinate, mizoribine all of which were insufficient to cure. Even after we applied 60 Gy/10 fr of interstitial radiotherapy to the upper lip under the di- agnosis as squamous cell carcinoma, the whitish plaque and concave expanded from the inside of the oral cavity to hardpalate (Figure 1(a) and Figure 1(b)). Laboratory finding showed a slight increase in inflammatory response at CRP 0.33 mg/dl (normal; less than 0.2), or HbA1c 6.3% (normal ranged from 4.6 to 6.2), including no increase in tumor markers at SCC 1.7 ng/ml (normal; less than 2), and no other significant items were noted. No findings of lymph node metastasis or distant metastasis were observed upon contrast-enhanced CT. Histopathological findings on the upper lip at the time of recurrence revealed dense inflammatory cell infiltration in the upper dermis along with individual cell necrosis and mild cell atypia in the papillomatous elongated epidermis (Figure 1(c) and Figure 1(d)). The patient was finally diagnosed with oral florid
There were three parameters which significantly differentiated patients in the groups by AHI but not by BMI: the distance between the hardpalate and posterior pharyngeal wall parallel to the horizontal plane, the shortest distance between soft palate and posterior pharyngeal wall as well as the transverse of the pharynx at the level of the posterior nasal spine. The results of statistical analysis suggested that the measured parameters were independent of obesity and crucial for pharyngeal obstruction in OSA patients The transverse of the pharynx at the level of the posterior nasal spine significantly differentiated pa- tients in the groups by gender and AHI, but not BMI (Tables 1, 3). Moreover, there was a slight, yet significant correlation (r = 0.35) between this sur- face and the value of the AHI. Whereas, transverse section of the pharynx at the level of the soft palate significantly differentiated patients in the groups by BMI only (Table 2).
contributory. On clinical examination numerous rounded to polygonal fleshy elevations were present on labial mucosa, sides of the tongue, at the junction between hard and soft palate and hardpalate itself. Their size ranged from 0.1 to 0.5 cm in diameter. They were soft to firm in consistency and nontender. Indirect laryngoscopy was normal. All the relevant laboratory investigations, i.e., complete blood picture, urinalysis, chest x-ray, thyroid function tests and scan were within normal limits. VDRL test• was negative. A biopsy was taken which showed epithelial hyperplasia with parakeratosis,
Dysphagia is one of the most important clinical prob- lems encountered in the treatment, rehabilitation and care of compromised elderly. It hinders undisturbed food and liquid intake and presents an inherent risk of aspirating. In bedbound patients it is frequently associ- ated with aspiration pneumonia, which is a possible cause of death [1-5]. The tongue and its pressure on the palate play a pertinent role in speech, deglutition, and mastication; and are of particular importance for the swallowing reflex [6-9]. Tongue pressure against the hardpalate is the largest oral pressure produced during swallowing. Measurements of tongue pressure against the palate have been performed by means of sensing probes, air filled bulbs and pressure sensors on an artifi- cial palate. Our original ultra-thin sensor sheet has enabled measurements of tongue pressure on five meas- uring points for the first time under nearly natural con- ditions and provided novel insights into the role of tongue pressure in healthy or pathological swallowing . Decline of tongue pressure and unfavourable tongue-palate contact was found in acute and chronic stroke patients with dysphagia.
METHODS: We retrospectively reviewed midline sagittal T2-weighted brain MR images of 126 consecutive patients to determine the mean angle subtended by the Talairach anterior commissure–posterior commissure (AC-PC) line and the hardpalate. On the basis of this data set, a new head CT protocol was instituted with pitch similarly prescribed relative to the hardpalate as identified on the lateral CT scout film. We then compared the precision of the new protocol, our former method (nominally parallel to the orbito-meatal line) and fixed-gantry angulation. Two head CT studies from 50 consecutive patients imaged with our old protocol and 50 consecutive patients imaged with our new protocol were reviewed for a total of 200 CT examinations.
Fourteen children who had undergone palatoplasty and were diagnosed as having velopharyngeal insufficiency by postoperative speech assessment underwent modified UVP by the same surgeon. Short-term and mid-term evaluations were performed at 1 and 3 years postopera- tion. The degree of hypernasality and the soft blowing test were evaluated and results were converted into scores. According to the total scores for both tests, velo- pharyngeal closure function was classified into four grades: “good”, “fair”, “slightly poor” and “poor”. At the short-term evaluation, 11 of the 14 patients (78.6%) were classified as “good” or “fair”. At 3 years postoperation, all of the 14 patients (100%) were classified as “good” or “fair”. Our results indicate that this modified UVP is effective to improve velopharyngeal insufficiency as sec- ondary surgery for cleft palate in children. It is recom- mended that hardpalate closure is first carried out prior to velopharyngeal plasty for children with velopharyngeal insufficiency in the two-stage palatoplasty.
The metrical comparison between the length of the palatine sutures of the male and female skulls revealed that they are of similar proportions. How- ever, there are differences between the sexes in the correlation between the lengths of the subsequent sutures of the hardpalate. This can be a result of a different pattern of growth that occurs in the hardpalate of the male and female skulls. The results obtained allow us to conclude that in the female skulls both the palatine processes of the maxilla and the horizontal laminae of the palatine bones may independently influence the length of the bony pala- te. An increase in the participation of the palatine bones in palate formation results in a decrease in