Case presentation (Perforation of the palate in leprosy)
From: Theuvenet, J. Willem, Apeldoorn, The Netherlands
Dear Dr. Krishna Bdr Tamang, Namasté!
Thank you for sharing the problems of this patient (LML Nov. 5th, 2010). The perforation in his palate is the result of the chronic inflammation of the mucosa of his nose as often seen in multibacillary leprosy. Is he not also having an erosion of his nasal septum?
The problems in eating and drinking can be partially elevated by a dentist/orthodontist who can make a removable palatal inlay for him that will cover his palate and should facilitate his eating and drinking. It will take a while after finishing his MDT and before the nasal inflammation has completely subsided. Only then it may be safe to make an attempt to reconstruct the palatal defect. Depending on the condition of his palate and the size of the defect the solution may be in a reconstruction according to Langenbeck or coverage with a dorsal tongue flap.
As you now have an excellent hospital for reconstructive surgery in the Kathmandu valley, with plastic surgeons skilled in cleft lip and palate repair, I would suggest that your patient seeks their advice in due time!
Wih kind regards,
Dr. Willem J.Theuvenet,
Plastic Surgeon
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