Palatal mucormycosis in a 2-month-old child: A very rare case report and a literature review

A 2-month-old Syrian male child presented with a large blackish ulcerating lesion on his hard palate, along with fever, diarrhea, vomiting, and milk regurgitation from the nose. The child was diagnosed with palatal mucormycosis by histopathology and underwent treatment with liposomal amphotericin B and surgical debridement. However, despite treatment, the child's condition deteriorated, and he died from respiratory failure. An underlying immunodeficiency was not diagnosed, but the family history revealed several deaths of the child's siblings at very early ages due to poorly documented complicated metabolic syndromes. An autopsy was refused by the parents due to cultural reasons.

Gross and microanatomic description of the dental pads of the Florida manatee, Trichechus manatus latirostris, and their importance to mastication

OBJECTIVE

Florida manatee feeding ecology is critical to species survival, but the role of dental pads in feeding has received limited attention. This study characterized the gross and microscopic anatomy of the manatee's dorsal and ventral dental pad in relation to these structures' importance in mastication, which furthers our understanding of manatee feeding and health.

DESIGN

Whole heads from 6 animals (4 male and 2 female) of varying sizes were examined grossly. Sections (5 µm) from throughout the dorsal and ventral dental pads were stained with Hematoxylin and Eosin to document microanatomy. The thickness of the epithelium and stratum corneum were measured.

RESULTS

The ventral dental pad epidermal (1129-3391 µm) and stratum corneum (331-1848 µm) thickness increased with increased body size. The dorsal dental pad epidermal (690-1988 µm) and stratum corneum (121-974 µm) thickness varied relative to size. The dental pad anatomy, including the thickened stratum corneum, indicates an importance similar to molars in grinding and physically breaking up plant material. Extensive appendages including filiform-like papillae and well-developed rete were observed and likely provide physical support for mastication.

CONCLUSION

While the sample size limits specific conclusions based on sex or age, it provides a good overview of the anatomy of the dental pads. The manatee is the only mammal known to have a ventral dental pad and the well-developed grinding surfaces demonstrates a crucial role in mastication for these structures. These dental pads should be evaluated during health checks and necropsies and considered in future research on manatee's feeding mechanisms.

Morphometric analysis of the palatine triangle in adult human skulls: a potential aid for anthropologists and intraoral bone grafts

Morphometrics of the hard palate is an important aspect of forensic anthropology and odontology. Palatine triangle is a triangular area in the hard palate formed by the palatine processes of the maxillae, which can aid intraoral bone grafts. We present the osteological measurements of the palatine triangle (maxillary palate) based on sex, compare it with other hard palate parameters, and establish the correlation between them. Seventy-seven male skulls and 36 female skulls were examined. Various morphometric measurements of the hard palate and palatine triangle were performed meticulously. Mean and standard deviation of each parameter were computed for groups using SPSS 16.0. Relationships between all parameters were analyzed using Pearson's rank correlation test. The mean palatine length was 38.84 ± 3.75 mm in males and 37.22 ± 4.12 mm in females; the mean palatine breadth was 31.36 ± 2.61 mm in males and 29.78 ± 3.07 mm in females. The mean area of the palatine triangle was 600.88 ± 80.16 mm2 in male skulls and 547.96 ± 94.28 mm2 in the female skulls. Statistically significant difference in various measurements of the palatine triangle and hard palate between the male and female skulls was noted. Leptostaphyline (narrow palate) was the most prominent type of palate. The area of the palatine triangle showed a strong positive correlation between the total length and breadth of the palate for both male and female skulls. A strong positive correlation was also observed between the palate length and the palatine triangle length. Palatine index and palate breadth had a statistically significant moderate linear relationship. The maxillary palate length, breadth, and area of the palatine triangle were higher in males when compared to females in South Indian origin skulls. Most of the skulls had a narrow palate. The results of this metric analysis of the palatine triangle may lead to a new concept of anatomical research into studying the hard palate, which can be used for sexual dimorphism.

Nicotina Stomatitis - A Report of Two Cases

Nicotina stomatitis is the inflammation of the minor salivary glands present in the hard palate due to chronic smoking habit. The patients are mostly symptomless and present with multiple red discrete papules in the hard palate surrounded by grayish white areas. The histopathology of the lesion is discussed and cessation of the smoking habit treats the condition within 2-4 weeks.

Anatomy of the greater palatine foramen and canal and their clinical significance in relation to the greater palatine artery: a systematic review and meta-analysis

PURPOSE

Accurate knowledge of greater palatine foramen (GPF) and greater palatine canal (GPC) anatomy is necessary to avoid injury to the greater palatine artery (GPA) when performing a variety of anesthesiologic, dental or surgical procedures. The aim of this paper was to perform a systematic review and meta-analysis of literature on the anatomy and localization of bony structures associated with the GPA, namely the GPF and GPC.

METHODS

A systematic literature search was performed using PubMed, Embase, ScienceDirect, and Web of Science databases. Seventy-five studies were included in the meta-analysis (n = 22,202 subjects).

RESULTS

The meta-analysis showed that the GPF is positioned 17.21 mm (95% CI = 16.34-18.09 mm) from the posterior nasal spine, 2.56 mm (95% CI = 1.90-3.22 mm) from the posterior border of the hard palate, 46.24 mm (95% CI = 44.30-48.18 mm) from the anterior nasal spine, 15.22 mm (95% CI = 15.00-15.43 mm) from the midline maxillary suture, 37.32 mm (95% CI = 36.19-38.45 mm) from the incisive foramen, and opposite the third maxillary molar (M3) in 64.9% (58.7-70.7%) of the total population.

CONCLUSION

An up-to-date, comprehensive analysis of GPF and GPC clinical anatomy is presented. The results from this evidence-based anatomical study provides a unified set of data to aid clinicians in their practice.

Computer-designed surgical templates improve the extraction of impacted supernumerary teeth in the hard palate

OBJECTIVES

The surgical procedure of bony impacted supernumerary teeth (SNT) in hard palate is commonly done with poor visualization and uncomfortable posture. This study aims to introduce our primary practice of presurgical evaluation and guiding exodontia of bony impacted supernumerary teeth (SNT) in the hard palate to reduce surgical trauma, duration and uncertainty.

STUDY DESIGN

Twelve patients with impacted supernumerary teeth in hard palate were included. Intraoral scan and the three-dimensional (3D) reconstruction of the cone beam computed tomography (CBCT) file was superimposed, and virtual simulation of flap elevation and osteotomy was conducted on the rebuilt 3D model. A couple of surgical templates were designed with surgical planning software Mimics, fabricated by a 3D printer and were used to guide the extraction of the impacted SNT.

RESULTS

The surgical templates fitted well to the teeth and operation site. All the impacted SNTs were accurately located and extracted without damaging the adjacent vital anatomical structures. All patients had an uneventful postoperative recovery without infection or sensory disturbance.

CONCLUSIONS

The application of 3D printed surgical templates reduced trauma and increased the accuracy and predictability of surgical extraction of bony impacted SNT in hard palate. The results of this study increased the accuracy and predictability of surgical extraction of bony impacted SNT in hard palate, and reduced the surgeon's embarrassment and surgical trauma because of location difficulty.

Investigation of the palatal soft tissue volume: a 3D virtual analysis for digital workflows and presurgical planning

Background

In mucogingival and implant surgery, an autologous soft tissue graft from the palate is the gold standard for reconstructing missing keratinised soft tissue and volume. Previously, presurgical measurements of the graft harvesting site were described with two-dimensional (2D) linear measurements. The present observational clinical study aimed to evaluate a three-dimensional (3D) measurement method for determining the present palatal soft tissue volume for each patient individually.

Methods

Pre-existing cone beam computed tomography (CBCT) scans of 20 patients were converted into 3D Standard Tessellation Language models of the bone surface. Intraoral impressions of the maxilla were taken and digitised to visualise the gingival surface. The resulting virtual models of bone (reference value) and gingival (actual value) surfaces were merged, with tooth surfaces used for registration. The region between the central incisors and the hard palate was subdivided into 5 regions of interest (ROIs). The distance between palatal bone and gingival surface was analysed both volumetrically and linearly, and the results were statistically evaluated for the ROIs.

Results

The average gingival surface area on the palate was 19.1 cm², and the mean volume was 58.2 cm³ (± 16.89). Among the ROIs, the mean linear value was highest in the most distal region, from the second molar to the hard palate (4.0 ± 1.09 mm) and lowest in the canine region (1.9 ± 0.63 mm). For mean distance, significant differences were found for the anterior palate and the most posterior palate in comparison with all other ROIs (p < 0.01). The volume measurements also declined significantly and steadily between the posterior (1.9 ± 1.0 cm³) and anterior palates (0.4 ± 0.2 cm³).

Conclusions

By merging digital data, palatal soft tissue could be quantified virtually. The results were reliable and comparable to previous findings with linear measurement methods. This 3D soft tissue volume analysis method fully exploited the diagnostic potential of data that are frequently collected for presurgical planning in oral surgery (i.e., CBCT + surface scans). This evaluation method might be useful for volumetric and linear measurements in other applications in anatomy and for determining palatal soft tissue dimensions in the planning stage before surgical interventions.

Trial registration

This observational clinical trial was retrospectively registered in the German Clinical Trials Register, reference number: DRKS00023918.

Do the dimensions of the hard palate have a relationship with the volumes of the upper airways and maxillary sinuses? A CBCT study

Background

As the hard palate is a central structure of the skull, and its close relationship with the nasal cavity, oral cavity, and maxillary sinuses, it would be of interest to study if there is a relationship between this bone and other structures of the stomatognathic system. Thus, this study aimed to assess the dimensions of the hard palate and associate them with sex, and skeletal and breathing patterns. Also, to investigate if there is a relationship between these dimensions and the volumes of the upper airways and maxillary sinuses.

Methods

Two hundred and ninety-eight CBCT scans of patients were classified according to sex, and skeletal and breathing patterns. Then, the linear dimensions of width and height of the hard palate at the regions of the first premolars and first molars, and the volumes of the upper airways and maxillary sinuses were measured using the CS 3D Imaging and ITK-SNAP software, respectively. Data were submitted to multi-way analysis of variance and linear regression, with a significance level of 5% (α = 0.05).

Results

Sex and facial type influenced the hard palate dimensions (p < 0.05). Males had greater width and height of the hard palate than females (p < 0.0001). It was observed greater width for brachycephalics at the first premolars region (p = 0.0032), and greater height for dolichocephalics at the first premolars (p = 0.0154) and first molars (p = 0.0038) regions. Skeletal malocclusion and breathing pattern did not influence the measurements of the hard palate (p > 0.05). There was a significant relationship between the width and height of the hard palate at the premolar’s region and the total volume of the upper airways (p = 0.018, and p = 0.038), and between both dimensions of the hard palate at the molar’s region and the total volume of the maxillary sinuses (p < 0.0001).

Conclusions

The hard palate dimensions are influenced by sex and facial type, but not by skeletal malocclusion or breathing pattern. Also, there is an association between these dimensions and the volumes of the upper airways and maxillary sinuses.

Evaluation of the nasal septum and depth of palatal arch in different facial vertical patterns: A Cone-Beam Computed Tomography Study

OBJECTIVE

The purpose of this study was to evaluate the nasal septum and the depth of posterior palatal arch in the different facial vertical patterns using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 143 CBCTs were analysed (53 normodivergents, 26 hypodivergents, and 64 hyperdivergents) using the software Real Scan 2.2. On the coronal view, the following measurements were taken, palatal interalveolar length (PIL), palatal arch depth (PAD), maxillopalatal arch angle (MPAA), septal vertical length (SVL), deviated septal length (DSL), and deviated septal curve angle (DSCA). Using the program Stata v16.0, we obtained the mean, standard deviation and median values. The identification of significant differences between facial biotypes was performed using the one-way ANOVA test and H of Kruskal-Wallis test, considering a significance level of 0.05.

RESULTS

The hypodivergent group got the highest PIL and MPAA (49.6mm and 118.1° respectively), with statistically significant differences (P<0.05) between this group and the hyperdivergent group. Statistically significant differences were found by gender for the SNMeGo, PFH, AFH, and the relationship between the facial heights, where the males had the highest values. Additionally, PIL and SVL also had the highest values for males (48.8mm and 63.6mm respectively).

CONCLUSIONS

Patients presenting with greater hyperdivergence have shorter interalveolar distances and smaller maxillopalatal arch angles.

Malignant tumors of the hard palate: Report of 4 cases and review of the literature

INTRODUCTION

Cancer of the hard palate is a fairly rare malignant tumor. Different histological types have been described in the hard palate, and that can affect its different structures. Diagnosis is based on biopsy with histological examination and possibly on immunohistochemical markers to confirm the diagnosis and exclude other diagnostic hypotheses. The aim of this study was to determine histopathologic, clinical and therapeutic characteristics of malignant tumors of the hard palate.

PATIENTS AND METHODS

A retrospective review of 4 patients who underwent Surgical resection by trans oral approach was performed for different histological types of malignant tumors of the hard palate. These included squamous cell carcinoma (case1 and case 2), mucosal melanoma (case 3), and adenocarcinoma (case 4).

RESULTS

The T stage was analyzed for all cases. Two cases were classified as T2 stage with a tumor size between 2 and 4 cm and the two others, given the extension to the maxillary and nasal cavity were classified as T4a. Cervical lymph node metastasis was found in three patients.

DISCUSSION

Surgical resection is the treatment of choice for malignant tumors of the hard palate. There is a variety of surgical procedures that can be used via a trans oral approach. Reconstruction of palatal defects with a prosthesis is sufficient, whereas larger defects will require a local, regional or even microvascular free tissue flap. The differences between these surgical techniques are presented, and indications are discussed.

CONCLUSION

The therapeutic management for malignant tumors of the hard palate is essentially surgical, with or without postoperative radiotherapy, discussed on a case-by-case basis. Survival rate depends on several factors, including early diagnosis, histological characteristic and appropriate management.

Electrical stimulation enhances early palatal wound healing in mice

BACKGROUND/OBJECTIVE

Electrical stimulation (ES) has been used to treat chronic wound and other clinical applications, showing favorable results in wound closure. It was hypothesized that ES can present a positive effect on oral mucosa healing. The aim of this study was to investigate the effects of ES during the palatal mucosa early healing process in Swiss mice.

METHODS

Ninety animals were divided into two groups: Control (C; n = 45), which received Sham ES applications, and Test (ES; n = 45), which received ES (100 μA; 9 kHz; 660 mVpp) once a day for 3 days. A full thickness wound was performed with a 1.5 mm diameter biopsy punch in the hard palate. Histologically, the following parameters were evaluated: palatal wound closure and epithelial and connective wound edge distance (EED and CED). Furthermore, IL-1β, IL-6, IL-10 TNF-α, and VEGF cytokine levels were evaluated by multiplex assay. The percentage of collagen fibers was assessed using the polarization method and the Smad proteins using the immunofluorescence method.

RESULTS

Palatal wound closure presented a significant reduction on day 5 in the ES group (p = 0.01). Additionally, both EED and CED were shorter for all time points in the ES group (p < 0.05), and the inflammatory markers IL-6, IL-10, TNF-α, and VEGF were reduced (p < 0.05). There were no differences in collagen fibers and phospho-Smad2 between the groups.

CONCLUSION

ES had a positive effect on early palatal wound closure outcomes, as well as on inflammatory markers.

Surgical Management of Palatal Pleomorphic Adenoma (PPA) Recurrence After 10 years, Treated at a Brazilian Center - A Case Report

Pleomorphic adenoma, considered the most frequent benign mixed neoplasm of the minor salivary glands, occurs mainly in the region of the hard palate, with slight predilection in females and peak of incidence between the third and fifth decades of life. An increase in recurrence rates has been associated with the histopathological variants of the tumor, cellular characteristics, stroma, and capsule rupture during surgical removal of the lesion. The present case report aims to describe the surgical approach performed on the patient, a 45-year-old woman with a recurrent Pleomorphic Adenoma (PA) in the region of the hard palate on the right side, 10 years after initial enucleation of the lesion; her main complaint was an increase in volume in the palatal region. After extensive local surgical excision of the tumor and 2 years of follow-up, there were no signs of recurrence. Computed tomography and a correct histopathological diagnosis are essential to enable the establishment of an appropriate surgical treatment, with the purpose of achieving complete removal of the lesion, with wide surgical margins, including the lining mucosa and the underlying periosteum, as described in the present case.

A Case of Fibrolipoma of the Hard Palate

An extremely rare case of fibrolipoma in the hard palate is presented and discussed with reference to the literature. An 85-year-old woman visited the Tokyo Dental College Chiba hospital in September 2016 with the chief complaint of a mass in the hard palate. The patient had first become aware of this mass several years earlier. An examination at another hospital in June 2009 resulted in a clinical diagnosis of lipoma. Regular examinations followed every 6 months until September 2014, at which time she stopped attending these appointments because there was no change. In August 2016, however, the patient realized that the tumor was increasing in size. Although there was no pain, awareness of a foreign body in the oral cavity when eating or talking was increasing, so she decided to visit our clinic for detailed examination and treatment. At this point, the mass extended from the center to the left side of the hard palate. It measured 15 mm along the major axis, and had a clear border; nearly spherical, its surface was smooth and glossy, and was of a slightly yellowish color. The mass was painless, elastic, and soft. Computed tomography and magnetic resonance imaging revealed a tumorous lesion. Based on a clinical diagnosis of lipoma, it was subsequently excised under general anesthesia in January 2017. The tumor lay under the palatal mucosa, extending from the center to the left side of the hard palate. It was surrounded by a single-layered membranous structure, and had not adhered to the surrounding tissues. Healthy palatal mucosa and periosteum were also removed en bloc with the tumor within a safety margin of approximately 5 mm. No pressure absorption of palatine bone was seen. Histopathologically, proliferation of mature adipose tissue was observed. This was surrounded by a thin, single-layer membrane within the subepithelial connective tissue, which was covered by stratified squamous epithelium. Proliferation of fibrotic connective tissue was seen between the adipocytes. The final diagnosis was fibrolipoma. To date, at 18 months postoperatively, no recurrence has been observed and progress has been satisfactory.

Clinical difference between benign and malignant tumors of the hard palate

OBJECTIVE

To determine the clinical characteristics and treatment results of benign and malignant tumors of the hard palate in our hospital.

PATIENTS AND METHODS

A total of 25 patients who underwent surgical treatment for hard palate tumors between 2008 and 2018 were included in this study. Their demographic characteristics, smoking status, alcohol consumption, symptoms, duration of symptoms, size and localization of hard palate tumor, status of mucosal surface, radiologic examinations, surgery, reconstruction method, histopathologic results, treatment outcomes, oral intake start time, adjuvant treatment, postoperative complications, and recurrence were reviewed.

RESULTS

Of the 25 patients with hard palate tumors, 15 (60.0%) had benign tumors and 10 (40.0%) had malignant tumors. Both benign and malignant tumors of the hard palate occurred more frequently in females than in the males. The most common symptom of hard palate tumor was palate mass. The most common benign tumor was pleomorphic adenoma (n = 13). The most common malignant tumors were squamous cell carcinoma and carcinoma ex pleomorphic adenoma (n = 3 for each). All patients were operated via transoral approach without external incision. We did not experience any recurrence in this study. The oral intake start time was late in malignant hard palate tumors (p < 0.05).

CONCLUSION

The comparison of clinical features of benign and malignant hard palate tumors showed a statistical significance only for oral intake start time. Transoral surgical removal with clear margin is a safe and effective procedure for benign and malignant hard palate tumors.

Lipoma of Hard Palate: Commonest Tumour at Rarest Site

Lipoma is the most common benign soft tissue tumor. Lipomas are relatively uncommon tumours in the oral cavity accounting only 1-4 %. Half of oral lipomas are in the cheek and the remaining is found in the tongue, floor of the mouth, lips, palate, and gingival mucosa. We are reporting a case of lipoma that occurred in the hard palate, which is extremely rare.

Pediatric hard palate foreign bodies: Case report and Systematic review of the literature

INTRODUCTION

Foreign body impaction in the pediatric hard palate is a rarely described otolaryngologic entity. It is often misdiagnosed as a neoplastic or an inflammatory lesion causing much stress to parents. The aim of this paper is to report a case managed in our department and to present a systematic review of the literature on pediatric hard palate foreign body impaction.

CASE REPORT

We present the case and the management of an impacted plastic screw cap in the hard palate of a 9 month-old boy.

MATERIAL AND METHODS

Following the PRISMA guidelines, a systematic review was conducted in August 2019 using Medline and Embase databases. Included articles were reviewed for mean age at presentation, gender, presumptive diagnosis, time to removal, foreign body type, average size, anesthesia type and complications.

RESULTS

32 reported cases were included. Foreign bodies were mistaken for other diagnoses in 24 cases. Mean duration from first presentation till removal was 56.9 days. Circular plastic covers were found in 20 cases. General anesthesia was used in 68% of the cases. No major complications were reported.

CONCLUSIONS

Foreign body impaction should be kept in the differential diagnosis of hard palate lesions in children. Up to date, this entity is still frequently misdiagnosed.

A Sizeable Solitary Pedunculated Peripheral Osteoma of the Hard Palate: A Case Report

Osteomas are benign, slow growing, usually sessile osteogenic tumors of unknown etiology. They arise from proliferation of either cancellous or compact bone. They can be central, peripheral or extra-skeletal based on their origin from endosteum, periosteum or extra-skeletal soft tissue respectively. They are commonly found in the skull and facial bones, the most common site in the maxillofacial region being paranasal sinuses. Among the jaw bones the most common site is the mandible. The hard palate is a rare site for such osteomas with a very few cases reported in literature. We report a case of large pedunculated peripheral osteoma of the hard palate in a 38 year old male. The tumor was excised with no recurrence after 3 years followup.

Facial changes related to brachycephaly in Cavalier King Charles Spaniels with Chiari-like malformation associated pain and secondary syringomyelia

BACKGROUND

Recent studies including an innovative machine learning technique indicated Chiari-like malformation (CM) is influenced by brachycephalic features.

OBJECTIVES

Morphometric analysis of facial anatomy and dysmorphia in CM-associated pain (CM-P) and syringomyelia (SM) in the Cavalier King Charles Spaniel (CKCS).

ANIMALS

Sixty-six client-owned CKCS.

METHODS

Retrospective study of anonymized T2W sagittal magnetic resonance imaging of 3 clinical groups: (1) 11 without central canal dilation (ccd) or SM (CM-N), (2) 15 with CM-P with no SM or <2 mm ccd (CM-P), and (3) 40 with syrinx width ≥4 mm (SM-S). Morphometric analysis assessed rostral skull flattening and position of the hard and soft palate relative to the cranial base in each clinical group and compared CKCS with and without SM-S.

RESULTS

Sixteen of 28 measured variables were associated to SM-S compared to CM-N and CM-P. Of these 6 were common to both groups. Predictive variables determined by discriminant analysis were (1) the ratio of cranial height with cranial length (P < .001 between SM-S and CM-N) and (2) the distance between the cerebrum and the frontal bone (P < .001 between SM-S and CM-P). CM-P had the lowest mean height of the maxillary area.

CONCLUSIONS AND CLINICAL IMPORTANCE

CKCS with CM-P and SM-S have cranial brachycephaly with osseous insufficiency in the skull with rostral flattening and increased proximity of the hard and soft palate to the cranial base. Changes are greatest with CM-P. These findings have relevance for understanding disease pathogenesis and for selection of head conformation for breeding purposes.

The oral manifestations of syphilitic disease: a case report

Background

Syphilis is a sexually transmitted bacterial infection of the spirochete, Treponema pallidum. While primary syphilis often involves genitalia, oral manifestations are observed in a subset of patients. These lesions are often associated with submandibular and cervical lymphadenopathy. This is a case report of a primary syphilitic lesion located on the hard palate of the oral cavity, with only a very few cases described previously.

Case presentation

We describe a rare case of syphilis in a 59-year-old African American man presenting with subjective fevers, chills, marked submental lymphadenopathy, a diffuse skin rash, and an ulcer of the hard palate.

Conclusions

This case report demonstrates the importance of maintaining a high index of suspicion for syphilitic infection when a patient presents with nonspecific symptoms, a diffuse rash, and an oral lesion.

Evaluation of sphenoid sinus variations by using cone beam computed tomography in patients with cleft lip/palate

OBJECTIVE

The purpose of this study is to evaluate the sphenoid sinus variations in patients with cleft lip/palate.

METHODS

Sixty three (63) patient's cone beam computed tomography (CBCT) images, taken from the head and neck region, were evaluated. Images were divided into two groups; [Group 1; patients with cleft lip/palate (CLP Group) (n = 23) Group 2; patients without cleft lip/palate (control group) (n = 40)]. The main pneumatization types (conchal, sellar, and presellar) of sphenoid sinuses were assessed on sagittal sections of the CBCT images. The sphenoid body, lateral and lesserwing types were evaluated on coronal sections and anterior type pneumatization was evaluated on axial sections.

RESULTS

The mean age ranged from 12 to 26 (16.57 ± 4.46) in Group 1 and 12 to 25 (16.58 ± 3.71) in Group 2. In both groups, the male and female distribution was found similar (P = 0.342). The sellar type was the most common pneumatization type of sphenoid sinus both for the Group 1 (91.3%) and Group 2 (80%). Any statistically significant difference was not found between the two groups in terms of the incidence of pneumatization types. Combined type pneumatization was detected in 65.6% of the Control group and 76.2% of the CLP group.

CONCLUSIONS

In this study, the prevalence of sphenoid sinus pneumatization types in CLP patients was compared with the normal population. Any significant difference was not determined in the two groups.

Sialadenoma papilliferum of the hard palate: A rare case report

Sialadenoma papilliferum (SP) is a rare benign salivary gland tumor with unclear cell origin. This report presents a new case of SP of the hard palate occurring in a 50-year-old female. The lesion was completely excised, and the microscopic features were consistent with SP. The knowledge of this rare entity contributes to proper diagnosis and prevents unnecessary radical surgery and treatment.

Chronic Candida osteomyelitis of hard palate and nose: A diagnostic quandary

Candida induced osteomyelitis is infrequent. There is scarcity of literature on this entity in maxillofacial region and thus there is possibility to mismanage such cases. We are presenting a case of chronic maxillofacial Candida tropicalis osteomyelitis causing palatal and septal perforation with saddle nose deformity in a young lady with commencement and progression of disease process over two pregnancies. Diagnosis was established by histopathology and repeated isolation on culture. Debridement followed by adequate antifungal therapy instituted.

Solitary neurofibroma of the palate mimicking mucocele: A rare case report

Neurofibroma is a benign, slow-growing, peripheral nerve neoplasm. It presents as a solitary tumor or component of neurofibromatosis (NF) and von Recklinghausen's disease. The occurrence of solitary neurofibromas in the oral cavity is less frequent, and those in the palate are reported in less numbers. This report describes an unusual case of solitary neurofibroma in the hard palate which clinically mimicked a mucocele.

Palate ulcer, uvular destruction and nasal septal perforation caused by Sporothrix brasiliensis in an HIV-infected patient

Sporotrichosis is a human and animal disease caused by dimorphic pathogenic species of the genus Sporothrix. We report a dramatic presentation of Sporothrix brasiliensis infection, with destruction of the nasal septum, soft palate, and uvula of an HIV-infected woman. She was successfully treated with amphotericin B deoxycholate followed by itraconazole. Sporotrichosis remains a neglected opportunistic infection in patients with AIDS and awareness of this potentially fatal infection is of utmost importance.

Three-dimensional morphological evaluation of the hard palate in Korean adults with mild-to-moderate obstructive sleep apnea

Objective

The purpose of this study was to evaluate differences in three-dimensional (3D) morphology of the hard palate between Korean adults with and without mild-to-moderate obstructive sleep apnea (OSA) using cone-beam computed tomographic (CBCT) data.

Methods

The protocol for the two-dimensional (2D) and 3D mathematical modeling was established by analyzing CBCT images of 30 adults with OSA and 30 matched controls without OSA, using MIMICS software. The linear and angular measurements were also determined using this software. The measurements were repeated for 30 palates, by the same operator, to assess reliability.

Results

The palates of OSA patients were higher in the posterior part and narrower in the anterior-superior part than those of the control group (p < 0.05). The nasal cavities of patients with OSA were narrower (p < 0.05) than those of controls. The increasing angle of the first molar palatal root is a compensation of the upper dental arch to improve occlusion. However, for most palatal measurements, there were no significant differences between the OSA and control groups (p > 0.05). The results of 2D and 3D mathematical models were consistent for linear and angular measurements, indicating that 2D and 3D mathematical modeling of the palate is a reliable methodology.

Conclusions

OSA is a multifactorial disease; the palates of adults with mild-to-moderate OSA do not have specific morphological features distinct from those of healthy controls.

Closure of fistula of the hard palate with two layers of mucoperiosteum

OBJECTIVE

Oronasal fistula represents a functional problem, as it may result in nasal regurgitation of food and fluids and it also leads to hypernasal speech. Many methods have been proposed for its closure with a high recurrence rate. The aim of this study was to assess the efficacy of closure of hard palate fistula by two layers of mucoperiosteal flaps.

METHODS

Eighteen patients with fistula of the hard palate were included. The fistula was repaired by two layers of mucoperiosteal flaps; the first layer was created from the mucoperiosteum surrounding the fistula as bilateral hinge flaps and the second layer was formed of a rotational flap based on the greater palatine artery. Pre- and postoperative clinical assessment was performed.

RESULTS

The etiology of fistulas was previous cleft palate repair in 13 patients, previous nasal septal surgery in 3 patients, and untreated sharp accidental trauma to the palate in 2 patients. All patients presented with nasal regurgitation and hypernasal speech. Complete closure of all fistulas was achieved at first attempt, with no recurrence through the follow up period.

CONCLUSIONS

Closure of oronasal fistula by two layers of mucoperiosteal flaps is an effective method and it has neither complications nor recurrence.

Kindler syndrome complicated by invasive squamous cell carcinoma of the palate

INTRODUCTION

Kindler syndrome is a very rare, autosomal recessive genodermatosis characterized by skin fragility and photosensitivity in infancy with progressive poikiloderma.

CASE REPORT

We report the case of a young woman with a history of Kindler syndrome predominantly characterized by extensive involvement of the oropharyngeal mucosa. The patient presented with an ulcerative lesion of the palate. Computed tomography and biopsy concluded on unresectable invasive squamous cell carcinoma of the hard palate. Neoadjuvant chemotherapy was proposed, but the patient died after the first course of chemotherapy in a context of severe gastrointestinal mucositis and generalized sepsis.

DISCUSSION

Mucosal manifestations of Kindler syndrome have been described in the literature, but very few cases of malignant transformation to squamous cell carcinoma have been reported, although it is a very well known, long-term complication of this disease. To our knowledge, this is the second reported case of Kindler syndrome complicated by invasive squamous cell carcinoma of the hard palate.

How reliable is the vomer flap in early hard palate repair?

Hard palate closure with a vomer flap at the time of lip repair has been widely adopted. A recent study by Deshpande et al. showed a high rate of failure of the vomer flap and led the authors to abandon the technique. We conducted a retrospective study of vomer flap healing in a consecutive series of cases performed by the senior author (D.O.). The case records of 71 patients who underwent repair of unilateral cleft lip and palate with a vomer flap at the time of lip repair were studied. Vomer flap healing was assessed and documented by the senior author at the time of definitive palate closure, and this was recorded. Adequate records were available for 66 cases. Twelve patients (18%) had associated syndromes and were included in the analysis. The median age at the time of lip and vomer flap repair was 3.5 months, and that at the time of palate repair was 8 months. At definitive palatoplasty, the vomer flap was intact in 62 patients (94%). Four patients (6%) had partial or complete failure of the vomer flap. All failures occurred in cases where the vomer flap was sutured directly to the nasal mucosa, a technique since abandoned in favour of double-breasting the flap to the raw surface of the oral mucosa. Five patients had incomplete healing of the palate following definitive palatoplasty, two of whom had a previous vomer flap failure. Contrary to Deshpande et al., we found the vomer flap to be highly reliable in closing the hard palate at the time of primary lip repair.

The Effects of Platelet-Rich Fibrin Membrane on Secondary Healing After Pleomorphic Adenoma Excision in the Hard Palate: A Preliminary Study

Aim:

This study aims to evaluate the effects of platelet-rich fibrin (PRF) membrane on secondary healing after pleomorphic adenoma (PA) excision in the hard palate.

Materials and Methods:

PRF membranes were laid over mucosal defects which occurred following PA excision in the hard palate. The secondary healing process was monitored in the patients by follow-up examinations on postoperative days 5, 10, 15, 20, 25, 30, 35, and 40.

Results:

In this preliminary study, epithelialization was observed to have completed on the 30^th day of follow-up in the first patient and on the 35^th day in the second and third patients. No bleeding or infection was seen in any of the three patients.

Conclusions:

PRF membrane as a new method in the secondary healing after PA excision in the hard palate provided rapid healing and reduced complications such as bleeding and infection.

Verruciform xanthoma in the hard palate: a case report and literature review

Oral verruciform xanthoma (OVX) is an uncommon lesion that appears on the oral mucosa. The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this lesion in the differential diagnosis of verrucous lesions. A 43-year-old male smoker presented with a painless lesion with a verrucous surface and erythematous spots on the hard palate. Excisional biopsy revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining. Immunohistochemical analysis revealed foam cells positive for anti-CD68 antibody, while anti-KI-67 antibody was restricted to the basal layer of the oral epithelium. A final diagnosis of OVX was established. The patient showed no signs of recurrence after seven months of follow-up. Physical trauma and smoking habits can be directly related to the etiology of verruciform xanthoma because the lesion is chronic and inflammatory with slow growth, and sites if high trauma are more often affected by such a lesion. The hard palate is the second most commonly affected site, and local trauma caused by smoking can be a cause of this type of lesion.

Primary B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma of the Hard Palate and Parotid Gland: Report of One Case and Review of the Literature

A 61-year-old woman was admitted to our hospital with an ulcerated palate mass and swelling of the right parotid gland. Incisional biopsy from the hard palate revealed an extranodal marginal zone B-cell lymphoma, also called mucosa-associated lymphoid tissue (MALT) lymphoma. Final diagnosis was MALT lymphoma of the parotid gland with concomitant involvement of an extremely seldom site of involvement: the hard palate. To our knowledge, this report illustrates the first case of MALT lymphoma of the hard palate and parotid gland without an underlying autoimmune disease. Rituximab-based combination regimen (R-CHOP) provided complete remission with total regression of mass lesions at the hard palate and parotid gland. At 44-month follow-up, there is no disease relapse. We adressed the manifestations and management of MALT lymphoma patients with involvement of salivary gland and oral cavity.

Binary logistic regression analysis of hard palate dimensions for sexing human crania

Sex determination is the preliminary step in every forensic investigation and the hard palate assumes significance in cranial sexing in cases involving burns and explosions due to its resistant nature and secluded location. This study analyzes the sexing potential of incisive foramen to posterior nasal spine length, palatine process of maxilla length, horizontal plate of palatine bone length and transverse length between the greater palatine foramina. The study deviates from the conventional method of measuring the maxillo-alveolar length and breadth as the dimensions considered in this study are more heat resistant and useful in situations with damaged alveolar margins. The study involves 50 male and 50 female adult dry skulls of Indian ethnic group. The dimensions measured were statistically analyzed using Student's t test, binary logistic regression and receiver operating characteristic curve. It was observed that the incisive foramen to posterior nasal spine length is a definite sex marker with sex predictability of 87.2%. The palatine process of maxilla length with 66.8% sex predictability and the horizontal plate of palatine bone length with 71.9% sex predictability cannot be relied upon as definite sex markers. The transverse length between the greater palatine foramina is statistically insignificant in sexing crania (P=0.318). Considering a significant overlap of values in both the sexes the palatal dimensions singularly cannot be relied upon for sexing. Nevertheless, considering the high sex predictability of incisive foramen to posterior nasal spine length this dimension can definitely be used to supplement other sexing evidence available to precisely conclude the cranial sex.

Mucocele of the hard palate in children

OBJECTIVE

Mucus retention cyst of the hard palate may result from obstruction of the ducts of the minor salivary glands, and it was defined as a mucocele. Although, the disease is not common in the hard palate, it was previously reported by many authors in the soft palate. The aim of our study was to present pediatric patients who were diagnosed to have mucocele of the hard palate, and to evaluate the outcome of the surgical excision of this lesion.

METHODS

This is a case series study included 8 pediatric patients who presented with cystic lesions on the hard palate which were removed surgically, and were diagnosed as mucoceles. Preoperative data, surgical procedures, and postoperative outcome were presented. Follow up of patients was performed for at least one year.

RESULTS

The swelling was detected as a single isolated lesion, on the side of the hard palate, covered with healthy mucosa, not tender, oval or round in shape, and measuring 0.4 to 1.7cm in its greatest dimension. Computed tomography showed a well defined cavity which was not invading the bone, and not disrupting the muscles of the palate. Histopathological examination confirmed that the lesion was a cavity that is lined with an epithelial layer with pseudoepitheliomatous hyperplasia. No patients developed intraoperative or postoperative complications, and no recurrence was detected in any patient.

CONCLUSIONS

Oral mucoceles can develop on the hard palate of the children, the lesions are mucus retention cysts. Complete surgical removal of the lesions with their cystic wall is a good treatment options, it carries no risk of recurrence.

Peripheral osteoma of the hard palate: a rare case report and literature review

Osteomas are benign osteogenic tumors that are composed of cancellous or compact bone. They are usually sessile tumours composed of dense sclerotic, well-formed bone projecting out from the cortical surface. They commonly occur in skull and facial bones, however, excluding the maxillary sinuses, the maxilla is a rare site for osteomas. Therefore, we aim to present a case of maxillary osteoma in a 19-year-old male patient and to provide an overview of current literature on the diagnostic options and treatment modalities. To best of our knowledge, in the English literature, this is the seventh reported case of maxillary osteoma which is located on the hard palate.

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).

Ill-fitting dentures as primary presentation of mantle cell lymphoma: A case report and literature review of the primary mantle cell lymphomas of the hard palate

Mantle cell lymphoma (MCL) is a subtype of B-cell non-Hodgkin's lymphoma seen predominantly in males. Common extra-nodal sites of involvement of MCL are Waldeyer's ring, gastrointestinal tract, bone marrow and peripheral blood. The extra-nodal palatal localization of MCL is quite uncommon. MCL is seen in predominantly older patients, therefore undiagnosed MCL patients are likely to have total prosthesis. In this study, a case of MCL, initially presenting as palatal swelling was reported with relevant literature review and the possible role of dental professionals in the diagnosis of this rare entity was discussed.

Slow-Growing Large Irritation Fibroma of the Anterior Hard Palate: A Case Report Using Immunohistochemical Analysis

Irritation fibromas are recognized as fibrous lesions, usually reactive hyperplasias; however, the mechanism of enlargement is unclear. This paper reports on an abnormally large irritation fibroma of extremely gradual growth. The immunohistochemical features (CD34, α-SMA, vimentin, Ki-67, and TGF-α) of this irritation fibroma are presented to distinguish reactive hyperplasia from other true fibrous neoplasm diseases. In the only previous study, it was reported that the expression of TGF-α might be associated with the development of oral fibromas. Therefore, we investigated the relationship between this exceptionally-large fibrous lesion of extremely slow growth and the immunohistochemical reactivity of TGF-α, finding that, in contrast to the previous study, TGF-α was not expressed. This is the first study to evaluate the enlargement mechanism of such a large irritation fibroma using the approach of immunohistochemical analysis, and it indicates that such analysis can help elucidate the diverse causes and enlargement mechanisms of irritation fibromas.

[Palatal fibromucosal graft to correct lower eyelid retraction]

INTRODUCTION

Retraction of the lower eyelids has multiple etiologies. Its surgical treatment is a vertical elongation of the tarsus. This can be obtained by using a graft. We describe a sampling and grafting technique using palatal fibromucosa intratarsal graft.

TECHNICAL NOTE

The procedure is performed in two steps under general anesthesia. The graft is harvested on the lateral sides of the palatine vault to avoid neurovascular bundles. This area corresponds to the maxillary fibromucosa according to Delaire's classification. The graft is then inserted in the lower eyelid tarsus.

DISCUSSION

Many "spacers" are available to extend the posterior lamella vertically; the palatal fibromucosa graft may be used directly and is easy to harvest. It has a similar stiffness to that of the tarsus and there is no need to harvest periosteum. Sparing the periosteum allows for a better healing of the donor site and decreases postoperative pain. The lateral harvesting area, away from the anterior palatine artery, seems more accessible than the median area, especially in ogival palates.

A rare case presentation of oral actinomycosis

Actinomycosis is an infectious disease caused by a gram-positive anaerobic or microaerophilic Actinomyces species that causes both chronic suppurative and granulomatous inflammation. The following study reports a 48-year-old Iranian woman presenting with a spontaneous discharging sinus on the hard palate for 8months. The patient has no past medical history of note. Laboratory findings were unremarkable. The diagnosis was based on history and clinical evidence of the lesion confirmed by histopathological examination. The patient was treated with a regimen of oral ampicillin 500mg four times a day. She had a marked response to the treatment after 4weeks, and it was planned to continue the treatment for at least 6months with regular follow-up. To the best of the researchers' knowledge, this is the first report of actinomycotic sinus tract of the hard palate in Iran.

Pleomorphic adenoma of hard palate: an experience

INTRODUCTION

Pleomorphic adenoma of minor salivary glands of hard palate is a rare benign tumour. It usually presents as slow growing submucosal mass on hard palate. The purpose of this study was to collect observational data regarding age, size, symptoms, CT findings and treatment of pleomorphic adenoma of hard palate.

MATERIAL AND METHODS

The prospective observational study was done in the Department of ENT, Department of Oral and maxillofacial surgery at SKIMS Medical College and at Peoples Care Polyclinic for a period of 2 years. Twenty cases were enrolled in the study. After clinical suspicion, computed tomography, FNAC and core needle biopsy was done in all twenty cases before any surgical intervention was done.

RESULTS

Most common age group seen to be involved was 16-30 years. Most common symptom was submucosal slow growing mass. Core biopsy was diagnostic with 100 % efficacy. On CT scan twelve patients (60 %) were seen to have intact hard palate even without minor erosions while four patients had full thickness erosion of hard palate. Surgical wide excision was done in all cases and one patient needed total maxillectomy. All treated patients were followed for one year and none showed signs of recurrence.

CONCLUSION

Pleomorphic adenoma of hard palate is usually seen in adults. Definitive diagnosis lies on histopathological examination. CT is necessary for ruling out any bony erosion. Treatment is by wide local excision.

Peripheral osteoma of the hard palate

Osteomas are benign slow growing, osteogenic lesions which may arise from proliferation of either cancellous or compact bone. They are usually sessile tumours composed of dense sclerotic, well formed bone projecting out from the cortical surface, most often of the skull and facial bones. This paper reports a case of a peripheral osteoma in the hard palate of a 45-year-old man, which was treated by periodontal flap surgery with surgical excision of the bony lesion. Peripheral osteomas of jaw bone are uncommon and usually associated with Gardner's syndrome. Histological examination confirmed the clinical impression of a peripheral osteoma. Patient was reviewed after one year and was asymptomatic with no recurrence of the lesion.

Perforation of the hard palate due to tuberculosis

Tuberculosis (TB) of the hard palate is rare and usually secondary to pulmonary TB. We present a case of a 7-year-old boy who presented with difficulty in swallowing solid foods, low-grade fever and loss of weight. Oral cavity examination showed perforation of the hard palate with an irregular, undermined margin and a necrotic base. Chest X-ray showed homogeneous opacity in the right upper zone. Fine-needle aspiration of the cervical lymph nodes showed granular caseous necrosis and granuloma composed of epitheliod cells and histiocytes. In view of the clinical presentation and evidence of pulmonary and lymph node TB, the palatal perforation was most likely due to TB. Patient was started on antituberculous therapy and is on regular follow-up.

Schwannoma of the hard palate

Schwannoma or neurilemmomas are benign, slow-growing, usually solitary, encapsulated tumors. They originate from the schwann cells of the nerve sheath. Approximately 30-40% of head and neck tumors are schwannomas. Intraoral schwannomas constitute a mere 1%. Tongue is the commonest site of schwannomas intraorally. Here we report a rare case of a hard palate swelling which was histopathologically diagnosed as schwannoma. The lesion was completely excised intraorally.

Clear cell predominant epithelial-myoepithelial carcinoma of the hard palate - role of immunohistochemistry

Epithelial-myoepithelial carcinoma (EMC) arising from the minor salivary gland of the hard palate is very rare. A 34-year-old lady presented with a nodular swelling in the hard palate. Histopathologically, a diagnosis of clear cell predominant EMC was suggested. Immunohistochemistry demonstrated the biphasic nature of the tumor and confirmed the diagnosis of EMC.