Speakers - 2026 Speakers

Title: Improvement of quality of life using a splint for palatal perforation caused by self-injury

Abstract

Among cases of self-injury in the oral and maxillofacial region, only one case with simultaneous nasal defect and palatal perforation was reported in 1978, making it extremely rare. The authors report on the treatment of a 67-year-old female patient who presented with nasal defect and palatal perforation as a result of self-injury.

The patient visited our department in 2006 with the chief complaint of food debris entering the nasal cavity due to a palatal perforation, accompanied by a nurse in a nursing care facility. The patient had a history of mental developmental delay and had been scratching the nasal cavity for over 30 years since the age of 27. Examination, including 3D-CT imaging, revealed nasal defects, crusting around the nasal area, a perforation in the central part of the palate (approximately 3 mm × 4 mm), and a palatal bone defect (approximately 28 mm × 24 mm).

As a treatment strategy, the authors chose to close the palatal perforation using a soft type of palate closure appliance (made of ethylene vinyl acetate resin, thickness: 3.0 mm) rather than surgical closure of the defect. An impression of the mucous membrane of the maxillary alveolar ridge including the perforation site was taken to fabricate the palatal closure plate, which was then fitted to the patient. Several feeding training sessions were conducted to confirm the acceptance of the palatal closure plate. Although, there was a tendency toward the enlargement of the perforation site (approximately 12 mm × 9 mm) in 2018, compared to the data in 2006, the patient's body weight increased by 4.0 kg, and BMI increased by 3.1. The patient and facility staff (caregivers, nurses) were satisfied with the effectiveness of the palatal closure device during meals. In 2024, the patient passed away at the age of 84.

The use of the palatal closure device is considered to have contributed to improved nutritional status and reduced self-injury to the palate and nasal area in the residential facility for over 18 years.

Audience take away from my presentation?

• Insights into historically significant cases.
• The usefulness of treatment using a soft type of palate closure appliance.
• Recognition of the importance of multidisciplinary collaboration between medical professionals and care facility staff.