Examination of soft

palate & hard palate

• Palate: The palate extends from the roof of the mouth all
the way back to the uvula.
• Hard Palate: The hard palate is made up of the anterior
two-thirds of the palatal vault supported by bone (palatine
processes of the maxillae and the horizontal plates of the
palatine bones).
• Soft Palate: The soft palate is made up of the posterior
one-third of the palatal vault that is not supported by bone.
The soft palate is a muscular extension from the posterior
edge of the hard palate, and the soft palate is very mobile,
especially while speaking and swallowing.

Inspection

Palpation .

• In general. . Examination of hard palate • The hard palate and maxillary tuberosity areas are examined using both direct and indirect vision and illumination. the tissue is a homogenous pale pink color. • Following the visual examination the clinician should digitally palpate the entire area using firm non-sliding pressure against the bone. firm to palpation towards the anterior and lateral to the midline while more compressible towards the posterior and medial to the apices of the teeth.

the tissue should be a homogenous pink color and firm to palpation . The normal structures of the hard palate that should be identified: • Incisive papilla – protuberance of soft tissue lingual to the maxillary central incisors which covers the incisive foramen and normally appears redder than the surrounding tissues • Raphe – slightly elevated line extending from the incisive papilla to the soft palate • Rugae – corrugated ridges radiating laterally from the raphe • Vault – relates to the depth and width of the palate • Maxillary tuberosities – area distal to the last molars.

. The palate is also a common area for unintentional tattoos resulting from pencil leads being jabbed into the tissues while playing with a pencil or holding it in the mouth. Pathologic findings Pigmented macules Pigmented lesions of any type should be identified to rule out melanoma.

Pigmented macules .

Thermal burns The anterior palate is the most common area for this type of traumatic injury .

Nicotine stomatitis Whitening and fissuring of the attached gingiva of the hard palate and inflammation of the minor salivary gland ducts .

Papillary hyperplasia Development of finger-like projections usually under a poorly fitting complete or partial denture .

Other traumatic lesions Abrasions and lacerations resulting from eating and factitial injuries .

Systemic related lesions Lesions related to lupus are commonly found in the palate and the palate is a prime location for the blue nevus .

Lesions of the Hard Palate • Torus Palatinus • Incisive Canal Cyst • Palatal Abscess • Benign Lymphoid Hyperplasia • Necrotizing Sialometaplasia • Pleomorphic Adenoma • Monomorphic Adenoma • Mucoepidermoid Carcinoma • Adenoid Cystic Carcinoma • Lymphoma Of the Palate .

Torus Palatinus • bony exostosis • 20% of adult • slowly increases in size • single .dome-shape bony hard swelling • midline of the hard palate • asymptomatic unless traumatized .smooth .

Torus Palatinus .

Incisive Canal Cyst • Developmental non odontogenic • Anywhere along the course of incisive canal • Generally confined to the palatal bone • Asymptomatic • A well developed incisive canal cyst may swell the entire anterior third of the hard palate • Radiographically : – delineated . symmetrically oval or heart shape radiolucency located between roots of vital central incisors • if located more posterorly in palate has been reffered to as the Median Palatal Cyst • Treatment is surgical enucleation .

Incisive Canal Cyst .

tissue swelling • Bacterial infection of the pulp • Associated tooth tender on percussion . Periapical Abscess • Fluctuant soft.

Benign Lymphoid Hyperplasia • reactive process • proliferation of the lymphoid tissue of the palate • age over 50 more affected • unknown etiology • usually soft .dome-shape or lumpy • surgical excision .

Benign Lymphoid Hyperplasia .

chiefly of accessory salivary glands • begins after trauma as a rapidly growing nodular swelling on the lateral aspect of the hard palate • usually after dental treatment • tissue infarction due to vasoconstriction and ischemia • initially small painless nodule • eventually enlarges and ulcerates and becomes painful • heals in 4-8 weeks • biopsy is recommended to rule out malignancy . Necrotizing sialometaplasia • reactive lesion .

Necrotizing sialometaplasia .

irregularly dome- shaped swelling • slow persistent enlargement over period of years • surgical excision . Pleomorphic Adenoma • most common benign neoplasm of accessory salivary gland • major and minor salivary glands • 55% on the palate • Occurs lateral to the midline • firm painless .non ulcerated .

Pleomorphic Adenoma .

dome. swelling on lateral to midline of the palate • Rapid growth and spontaneous ulceration indicating rapid malignant growth • Bluish appearance and/or mucous exudate emanating from the ulcerated surface of the swelling are distinctive for mucoeperdimiod carcinoma • Treatment is radical excision . Mucoepidermoid Carcinoma and Adenoid Cysytic Carcinoma • Two most common introral malignant accessory salivary gland neoplasms • Ages 20 to 50 affected by mucoepidermoid carcinoma • Ages over 50 affected by adenoid carcinoma • Asymptomatic.shaped. firm.

Mucoepidermoid Carcinoma .

• Normally. this area is slightly less vascular than the oropharynx and is usually reddish pink in color. • The tissue will have a homogenous. • Observe the area as the patient says “ah”. • Atypical observations include yellowish coloring due to increased adipose tissue (especially in older patients). • If palpation is necessary a topical anaesthetic should be used and the tissues should be palpated from the mid line out towards the lateral surfaces. Examination of soft palate • This area is examined using direct vision and is normally not palpated unless necessary. mobile and symmetrical during function. . • The tissue should appear loose. spongy consistency on palpation.

Lesions of the Soft Palat • Petechiae • Pemphigus vulgaris • Herpangina • Oral thrush .

Petechiae • mainly associated with Streptococcal pharyngitis • small red spots • not more than 3mm • uncommon but highly specific finding .

Pemphigus vulgaris •  Autoimmune disease • Flaccid blisters and mucocutaneous erosions • Positive nikolsky's sign • Painful .

surrounded by an intense areola • Lesions coalesce and ulcerate leaving a shallow crater • Lesions disappear in 5-10 days • Treatment is supportive . Herpangina • Coxsackie virus and echovirus • Yellowish white. vesicles in the throat.

Oral thrush • Acute pseudomembranous candidiasis • Most common type  • Coating or individual patches of pseudomembranous white slough • Easily wiped away to reveal erythematous mucosa beneath .

. Congenital cleft palate • An opening in the roof of the mouth • failure of the palatal shelves to come fully together • communication between the nasal passages and the mouth. • occur alone or in association with cleft lip.

References • Textbook of Oral Medicine   Anil Govindarao Ghom • Srb's Clinical Methods in Surgery Sriram Bhat .

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