Giant rhinolith: Still a neglected entity in modern era

Word rhino- and - lith, literally meaning “nose & stone”. So, it is basically a stone that forms inside the nasal cavity. It is an uncommon disease that may present asymptomatically or as an accidental finding. Rhinolith itself is a rare condition out of which giant rhinolith case is extremely rare. If left undiagnosed or untreated it can cause rhinosinusitis, erosion of the nasal septum & medial wall of maxillary sinus & palatal perforation.

Palatal perforation from intranasal abuse of heroin. Case report and literature review

Palatal perforation is a lesion of various etiologies, including chronic intranasal abuse of cocaine. Only a few data, however, correlate this damage with heroin. The growing intranasal abuse of heroin and the fact that it is one of the five most popular drugs in most European countries, especially in the lower social classes, increase the need for further investigation of its effects on the oral cavity and nasopharynx. This report presents a case of chronic snorting of heroin, which caused perforation of the hard palate, the diagnostic approach, the selected surgical technique, the final outcome, as well as a review of literature.

Cocaine-Induced Midline Destructive Lesions: A Real Challenge in Oral Rehabilitation

Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.

Management of palatal perforation in systemic lupus erythematosus patient

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease which damages tissues and causes chronic inflammation with an idiopathic etiology. It has been suggested that oral lesions in patients with SLE can be grouped clinically as erythema, discoid lesions and oral ulcerations. The latter have been said to indicate the onset of a severe systemic disease flare and that oral ulcers represent cases of mucosal vasculitis. Palatal lesions generally present in the form of ulcers or, in more severe forms, as perforation. Acquired palatal perforations can be caused by several etiologies including: developmental disorders, malignancy and infections. Purpose: To report the management of palatal perforation in an SLE patient. Case: A 14-year-old female patient attended the Dr. Ramelan Naval Hospital, with both a perforated palate that often caused her to choke when eating or drinking and maxillary anterior tooth mobility. Case Management: The treatment for the patient in this case consisted of debridement and DHE, pharmacological therapy including aloclair gel and minosep mouthwash to maintain oral hygiene and prevent re-infection. At the end of the first consultation, the patient was prescribed an obturator in order to avoid oro-anthral infection. During the second consultation, the patient’s orthodontic bracket was removed to facilitate scaling and splinting of the anterior maxillary teeth carried out to prevent their movement. During the third consultation, a swab was taken by an oral surgeon who also administered antifungal therapy. During the fourth and final consultation, the patient was examined a prosthodontic specialist due to an obturator which was causing discomfort. Conclusion: The management of palatal perforation lesions in an SLE patient requires a multidisiplinary approach.