Hard Palate Perforation in an Elderly Man With Dementia

Abstract

A 74-year-old male with a history of mild cognitive impairment presented to the emergency department with failure to thrive and generalized weakness. He was having difficulty swallowing leading to 30 pounds of unintentional weight loss in the last three months. His social history was significant for 12.5 pack-year smoking and drinking (two to three glasses of wine/day). The oral cavity examination revealed a large (3 × 2 cm 2 ) defect with the erythematous border that encompassed the mid-palatal structures and emanated from the hard palate into his nasal cavity. Auto-immune work-up was negative. Palatal biopsy showed squamous cell carcinoma (SCC; well-differentiated). A diagnosis of locally advanced (stage IVa) oral cavity squamous cell carcinoma (OSCC) was made based on PET scan findings. A palatal obturator (prosthesis) was placed to improve his eating, prevent regurgitation. The patient opted for palliative care and did not want to pursue further treatment. He was discharged home with a regular follow-up visit.

Process of Hard Palate Osteonecrosis Demonstrated on Serial 18F-FDG PET/CT Scans

“…Osteonecrosis of the hard palate is rare and may be related to various risk factors such as the procedure of artery embolization for refractory epistaxis, 1,2 local anesthetic infiltration, 3 cocaine misuse, 4,5 bisphosphonate usage, 6,7 and neoplasms. 8 In this case, the osteonecrosis of the hard palate might be secondary to lymphoma and its treatment. The imaging features of the osteonecrosis of the hard palate have not been well known.…”

“…The clinical symptoms and dynamic imaging findings suggested a diagnosis of osteonecrosis of the hard palate. Osteonecrosis of the hard palate is rare and may be related to various risk factors such as the procedure of artery embolization for refractory epistaxis, 1,2 local anesthetic infiltration, 3 cocaine misuse, 4,5 bisphosphonate usage, 6,7 and neoplasms 8 . In this case, the osteonecrosis of the hard palate might be secondary to lymphoma and its treatment.…”