Perforation of palate is/are seen with:

Causes of palatal perforation Developmental: During the sixth week of prenatal period, palatal shelve coalesce to form the hard palate. Failure to this integration results in cleft palate. Some syndromes, maternal alcohol consumption and cigarette smoking, folic acid deficiency, coicosteroid use and anticonvulsant therapy are some causative agents for this abnormality. Infectious: Leprosy, teiary syphilis, tuberculosis, rhinoscleroderma, naso-oral blastomycosis, leishmaniasis, actinomycosis, histoplasmosis, coccidiomycosis and diphtheria. Autoimmune: Lupus erythematosus, sarcoidosis, Crohn's disease and Wegener's granulomatosis. Neoplastic: Different tumors can extend from maxillary sinus or nasal cavity and perforate the palate. Although these neoplasms usually form a mass, but in advanced cases perforation of palate may occur in course of disease or following treatment. Drug related: Palatal perforation due to cocaine abuse is a well-known situation. Other durgs (heroine, narcotics) can be responsible for palatal perforation. latrogenic: Sometimes following a tooth extraction an oro-antral fistula remains. Other procedures such as tumor surgery (maxillectomy), corrective surgeries (e.g. septoplasty) or intubation can cause palatal perforation. Rare causes: Rhinolith can result in palatal perforation. Patients with psychologic problems may present with a fictitious palatal perforation.