Inspect the Hard and Soft Palates

Inspect the rugae and vault shape of the palates. Also inspect the palates for ulceration and masses. Masses are usually minor salivary gland tumors, mostly malignant. Are any white plaques present? Is the soft palate edematous? Is the uvula in the midline?

Is the palate intact? Figure 12-32 shows a severe cleft palate. Clefts of the palate and lips are distinct entities but are closely related embryologically, functionally, and genetically. The incidence of an isolated cleft palate is 1 per 1000 births. Clefts of the palate vary widely in size and shape. They can extend from the soft palate, to the hard palate, and to the incisive foramen. Recurrent otitis media, hearing loss, and speech defects are frequent complications.

In patients with impaired immunity, or in those whose microbial flora has been altered by antibiotics, Candida albicans, a normal commensal organism of the gastrointestinal tract, can

Wisdom Teeth Hematoma

Figure 12-32 Cleft palate.

Palatal Petechiae Pharyngitis Otitis
Figure 12-33 Pseudomembranous candidiasis.

Figure 12-32 Cleft palate.

become highly invasive, as seen in Figure 12-33. The patient, who has AIDS, has pseudomembranous candidiasis of the palate and uvula.

Are petechiae present? Petechiae are commonly seen in association with infective endocarditis, leukemia, oral sex, and viral infections such as infectious mononucleosis. Fellatio can result in palatal petechiae, characteristically at the junction of the hard and soft palates, as pictured in Figure 12-34.

A common finding is a torus palatinus, which is a discrete, hard, lobulated swelling in the midline of the posterior portion of the hard palate. This benign lesion is an overgrowth of the palatine bone. It is painless and asymptomatic and occurs twice as often in women as in men. It may remain undetected until it interferes with the fit of a denture. More than 20% of the population have at least a small torus palatinus. Figure 12-35 shows tori palatini in two patients. Not uncommonly, individuals may have multiple tori palatini;Figure 12-36 shows a patient with three tori palatini. A torus mandibularis is a hard, bony, often bilateral swelling that protrudes from the lingual surface of the mandible at the level of the premolar teeth. It is much less common than a torus palatinus. About 5% to 10% of the population have a torus mandibularis;however, one fifth of mandibular tori are unilateral. Figure 12-37 shows bilateral mandibular tori in two patients.

Figure 12-38 shows a patient with early invasive erythroplakia (red plaque) of the palate.

Petechiae Hard Palate
Figure 12-34 Palatal petechiae.
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