Examination of Soft Palate & Hard Palate

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
Examination of hard
palate
The hard palate and maxillary tuberosity areas are examined
using both direct and indirect vision and illumination.
Following the visual examination the clinician should digitally
palpate the entire area using firm non-sliding pressure against
the bone.
In general, the tissue is a homogenous pale pink color, 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 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
tissue should be a homogenous pink color and firm to
palpation
Pathologic findings
Pigmented macules
Pigmented lesions of any type should be

identified to rule out melanoma. 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.
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 ,smooth ,dome-shape bony
hard swelling
midline of the hard palate
asymptomatic unless traumatized
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
Periapical Abscess
Fluctuant soft- tissue swelling
Bacterial infection of the pulp
Associated tooth tender on percussion
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
Necrotizing
sialometaplasia
reactive lesion ,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
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 ,irregularly dome-
shaped swelling
slow persistent enlargement over period of
years
surgical excision
Pleomorphic Adenoma
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, firm, dome- shaped, 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
Examination of soft
palate
This area is examined using direct vision and is normally not
palpated unless necessary.
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.
Normally, this area is slightly less vascular than the oropharynx and
is usually reddish pink in color.
Observe the area as the patient says ah.
The tissue should appear loose, mobile and symmetrical during
function.
The tissue will have a homogenous, spongy consistency on
palpation.
Atypical observations include yellowish coloring due to increased
adipose tissue (especially in older patients).
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
Herpangina
Coxsackie virus and
echovirus
Yellowish white, vesicles
in the throat, surrounded
by an intense areola
Lesions coalesce and
ulcerate leaving a shallow
crater
Lesions disappear in 5-10
days
Treatment is supportive
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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Examination of Soft Palate & Hard Palate

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Examination of soft

palate & hard palate

Incisive papilla protuberance of soft tissue lingual to the

Pigmented lesions of any type should be

Lesions related to lupus are commonly found in the

Two most common introral malignant accessory

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