Understanding 2 Holes in the Roof of the Mouth - Causes, Symptoms, Diagnosis and Treatment

Understanding 2 Holes in the Roof of the Mouth

The roof of the mouth, known as the palate, is the bony structure that separates the oral cavity from the nasal cavity. It plays an important role in eating and speaking. The palate is divided into two parts - the hard palate at the front and the soft palate at the back. The hard palate provides a rigid floor to the mouth while the soft palate creates a flexible wall to separate the mouth from the pharynx during swallowing.

Two holes in the roof of the mouth is an uncommon condition. These openings are known as palatal fistulas. They allow a direct communication between the oral cavity and the nasal cavity. While mostly seen as congenital defects in infants, palatal fistulas can also develop later in life following surgery, trauma, infection or tumor growth in the mouth.

Causes of 2 Holes in the Roof of the Mouth

Some of the common causes of palatal fistulas include:

• Cleft palate - Cleft palate is a birth defect where the two plates of the skull that form the hard palate do not completely fuse together leaving a hole or cleft in the roof of the mouth.
• Surgery - Palatal fistulas can occur as a complication following palatal surgery like cleft palate repair. They are more common after repeated surgeries.
• Injury - A penetrating injury to the mouth by a sharp object can puncture a hole in the palate.
• Infection - Chronic infections of the mouth due to conditions like gum disease can slowly erode the bony palate leading to hole formation.
• Tumor - Both benign and malignant tumors of the palate may eventually ulcerate leading to palatal fistula.
• Chemotherapy/Radiation - Cancer treatment with chemotherapy and radiation therapy can damage the palate tissue and cause it to break down.

Symptoms of 2 Holes in the Roof of the Mouth

Some of the common symptoms and signs caused by palatal fistulas include:

• Nasal regurgitation of fluids - Because of the hole connecting the mouth and nose, liquids tend to regurgitate into the nasal cavity when swallowing.
• Difficulty eating/drinking - People have to consciously close off the nasal passage when swallowing food or liquids. Some may avoid meals because of this.
• Nasal speech - Communication is affected as air escapes through the nose during speech.
• Halitosis - Food particles can get lodged in the nasal cavity causing foul smelling breath.
• Nasal congestion - Chronic inflammation due to food and liquid reflux can cause swelling of nasal tissue and nasal discharge.
• Visible hole in the mouth - The fistula appears as an oval opening in the midline of the palate. Its edges may be red and inflamed.

Diagnosis of Palatal Fistulas

Palatal fistulas are diagnosed with the following investigations:

• Medical history - The doctor will inquire about previous oral surgery, trauma, infection or birth defects.
• Physical exam - A small torchlight is used to illuminate the oral cavity and inspect the palate.
• Imaging - X-rays, CT scan or MRI may be done to evaluate the size and location of the defect.
• Nasal endoscopy - A small flexible tube with a camera is inserted through the nostril to examine the nasal cavity.

Treatment for 2 Holes in the Roof of the Mouth

Treatment options for palatal fistulas include:

Medical Management

This involves dealing with symptoms and preventing food/liquid from entering the nasal cavity.

• Antibiotics - Prescribed if sinus or nasal infections develop.
• Nasal decongestants - Used temporarily to reduce nasal congestion.
• Frequent meals - Taking small frequent meals makes swallowing easier.
• Head elevation - Keeping the head elevated while eating or drinking allows gravity to prevent nasal regurgitation.
• Special feeding devices - A palatal lift prosthesis can be customized to close off the fistula during meals.

Surgical Repair

This is done once local inflammation has resolved and sinus/nasal infections are treated.

• Fistula closure - The epithelial edges are excised and the defect is sutured closed in layers.
• Flap reconstruction - Nearby oral tissue is mobilized and transposed to cover the fistula.
• Bone grafting - Bone harvested from the hip may be required if the hole is very large.

The surgery is done under general anesthesia. Success rates are over 90% if palatal tissue is healthy. In some cases, repeat procedures may be required if the fistula reopens.

Prevention of Palatal Fistulas

Preventive strategies include:

• Avoid repeated palatal surgery whenever possible.
• Careful cleft palate repair using modern plastic surgery techniques.
• Manage oral infections promptly with antibiotics.
• Practice good oral hygiene to prevent gum disease.
• Wear a mouthguard during contact sports.
• Avoid tobacco and alcohol which increase oral cancer risk.
• Protect the face during activities like cycling and construction work.

Prognosis of 2 Holes in the Roof of the Mouth

With appropriate treatment, most palatal fistulas can be successfully repaired. The prognosis depends on:

• Size of fistula - Small holes (<0.5 cm) have better outcomes.
• Scarring - Severe scarring around the fistula makes repair difficult.
• Cause - Traumatic fistulas have higher recurrence than those from cleft palate.
• Oral hygiene - Good dental care reduces infection risk.
• Healthy tissue - Tension-free repair needs adjacent healthy palatal tissue.

Surgical closure successfully fixes 90-95% of small palatal fistulas. However, the defect may reopen in 5-10% of patients requiring further surgery. With larger fistulas or in the presence of scarring, success rates drop to 50-80%.

With successful repair, symptoms like nasal speech and regurgitation resolve. Individuals can return to a normal diet and enjoy improved quality of life.

When to See a Doctor

Consult a doctor promptly if you notice any of the following:

• A new hole in the roof of the mouth.
• Fluid leaking from the nose while drinking.
• Difficulty swallowing food or liquid.
• Foul smelling nasal discharge.
• Bleeding from the hole in the palate.
• Pain or burning sensation in the palate.

Early evaluation and treatment provides the best results and prevents complications. Palatal fistulas are best managed by an oral surgeon or otolaryngologist. Consult your primary physician or dentist who will refer you to the appropriate specialist.

Conclusion

The presence of two holes in the roof of the mouth or palatal fistulas can significantly affect speech and swallowing. While often congenital, these defects can also occur later in life due to trauma, infection or tumors. Symptoms include nasal regurgitation of fluids and difficulty eating. Small fistulas are usually repairable with surgery. Larger defects may need multiple procedures for closure. Prompt evaluation allows early treatment and improves outcomes. With successful repair, individuals can regain normal palatal function.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.