Abstract

TITINCHI, F; BEHARDIEN, N; MORKEL, J  and  OPPERMAN, J. Perforation of the palate - A report of two Syphilitic Gumma cases. S. Afr. dent. j. [online]. 2020, vol.75, n.6, pp.311-315. ISSN 0375-1562.  http://dx.doi.org/10.17159/2519-0105/2020/v75no6a4.

Syphilis has recently shown resurgence in its incidence especially in immune-compromised patients. We present two cases of tertiary syphilis in middle-aged males with large perforations in the hard and soft palates, one of which had Human Immunodeficiency Virus (HIV) co-infection. Diagnosis was initially difficult due to non-specific features mimicking other conditions such as perforation of cocaine abuse aetiology, neoplastic conditions, sarcoi-dosis, fungal infections, bacterial infections other than Treponema pallidum and Wegeners granulomatosis. With special investigations including Anti-Treponema Immunohistochemistry and histology, however, a definitive diagnosis of syphilitic gumma was reached. Intravenous penicillin was the mainstay of management along with treatment of the underlying medical conditions. A removable acrylic obturator was used to close the oro-nasal fistula to improve swallowing and speech. Syphilis should be included as a differential diagnosis in cases of palatal perforation.

Keywords : Orofacial syphilis; Treponema pallidum; gumma; oronasal fistula.

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