Improvement in Quality of Life Using an Ethylene-Vinyl Acetate Palatal Obturator in a Patient with Self-Inflicted Nasal Defect and Palatal Perforation.

Abstract

A 67-year-old female patient with intellectual disability presented with a self-inflicted nasal defect and palatal perforation. In 2006, she was referred to our department by a nurse from her care facility with the chief complaint of food leakage into the nasal cavity due to the palatal perforation. Her medical history revealed a long-standing habit of scratching the nasal cavity, which had persisted for more than 30 years since approximately 27 years of age. Clinical and radiographic examinations, including three-dimensional computed tomography (3D-CT), demonstrated a nasal defect, crust formation around the nasal region, a perforation in the central palate (approximately 3 × 4 mm), and a palatal bone defect (approximately 28 × 24 mm). We selected a conservative approach using a soft palatal obturator made of ethylene-vinyl acetate (thickness: 3.0 mm) instead of surgical closure. In 2007, after several sessions of assisted feeding training with verbal encouragement, the patient accepted the use of the obturator. Although enlargement of the perforation (approximately 12 × 9 mm) was observed in 2018, her body weight increased by 4.0 kg and body mass index (BMI) improved by 3.1 compared with baseline values in 2006. In addition, no hospitalization due to aspiration pneumonia or other systemic complications occurred during the approximately 18-year follow-up period. The patient died at the age of 84 in 2024. The long-term use of a palatal obturator in a care facility setting may have contributed to improved nutritional status and reduced self-injurious behavior.