Non-neoplasic and non-syndromic palatal perforations. Presentation of 5 cases and systematic review of the literature

Abstract

Background: Palatal perforations not associated with syndromes or neoplasms are rare lesions whose frequency has increased recently. However, their clinical and demographic characteristics have not been fully described. Therefore, this report aimed to establish the demographic and clinical characteristics of patients with non-syndromic and non-neoplastic palatal perforations.

Material and methods: The file of an oral medicine teaching clinic from January 2004 to December 2018 was reviewed to identify and isolate all cases with a diagnosis of palatal perforation. Cases with a diagnosis of palatal perforation related to congenital alteration, syndrome, or neoplasia were excluded. Age, sex, medical history, and diagnosis were obtained from the clinical history. In addition, a systematic review of the literature was performed using a PICO strategy. MEDLINE electronic databases from January 1990 to December 2018 were systematically reviewed using the combination of keywords with Boolean terms "OR" (palatal perforation, destruction of the palate) and "AND" (drugs, cocaine, mycosis, syphilis, mucormycosis, tuberculosis, trauma). The PRISMA guide was used to identify the different results of the literature search and article selection process. Case reports and case series were included.

Results: Five cases of non-syndromic, non-neoplastic palatal perforations were identified. All cases were male with a mean age of 42 years. Two cases were related to cocaine use, 2 cases were caused by mucormycosis, and one case by trauma. As for the systematic literature review, 51 non-neoplastic and non-syndromic cases were collected. The cases showed a male predominance, with a mean age of 41 years. The most frequent etiology was chronic cocaine use followed by mucormycosis.

Conclusions: Since cocaine use and type II Diabetes Mellitus, risk factors related to non-syndromic and non-neoplastic palatal perforations, have shown a worldwide increase, the clinician should be alert to make an early diagnosis and initiate appropriate treatment. Key words:Palatal perforation, cocaine-induced, mucormycosis, mycotic infection, drug users.

Figure 1

Clinical aspects of 5 cases of non-syndromic and non-neoplastic palate perforations. A. Palatal perforation of a circular shape in a 69-year diabetic man with a previous diagnosis of palatal mucormycosis (Case 1). Notice the oval perforation located in the middle line of the hard palate. B. Palatal perforation in a 56-year male, consuetudinary cocaine consumer. Notice the oronasal communication of circular shape and 4 cm in diameter. Observes the surrounding reddish halo corresponding to erythematous candidiasis and caseous necrosis at their bottom (Case 2). C. A 58-year uncontrolled diabetic male patient and with a diagnosis of mucormycosis show two oval-shaped ulcers sited at both sides of the midline of the hard palate. The bottom of both ulcers showed caseous necrosis (Case 3).D. Palatal perforation in a 25-year male, consuetudinary cocaine consumer. Notice the well-defined circularly palatal perforation (Case 4).

Figure 2

PRISMA Flow diagram.