Papilloma of the dorsal aspect of the soft palate: a difficult lesion to visualize. (Rhinoscopic Clinic).

A 27-year-old man came to us complaining of a sensation that something had been present in the roof of his mouth for the previous 6 months. He added that he occasionally experienced a sensation of pruritus in the area. Neither the patient nor his primary care physician had detected any abnormality on inspection and palpation. The patient denied sore throat, dysphagia, odynophagia, and otalgia.

Our findings on an otolaryngologic examination of the patient's head and neck with an otoscope, headlight, and nasal speculum were unremarkable. Findings on indirect laryngoscopy were also negative. However, flexible fiberoptic nasopharyngoscopy with an Olympus ENF-P4 scope detected a lesion on the dorsal surface of the soft palate. In order to obtain a better view, we used two transoral retrograde telescopes (figure).

The patient was taken to the operating suite. Under general anesthesia, the lesion was excised from the oropharynx transorally. Telescopic nasopharyngoscopy confirmed that the excision was complete. On histologic analysis, the lesion was identified as a benign papilloma. Postoperatively, the patient noted a resolution of his symptoms.

A lesion of the dorsal aspect of the softpalate is difficult to diagnose and document. Transnasal fiberoptic nasopharyngoscopy might detect the lesion if the fiberscope is passed carefully and slowly. This view can be documented with a transoral retrograde telescope, such as the Nagashima SFN (110[degrees]) nasopharyngoscope and the Karl Storz 8700D (90[degrees]) and 8700E (120[degrees]) telescopes. Surgical treatment is best performed transorally with the patient in Rose's position and with the uvula fixed with a suture or an Allis clamp. Depending on the size of the lesion, it can be removed either by local excision with a sharp or Bovie's dissection or by a uvulectomy or partial excision of the soft palate.

From the Southern New England Ear, Nose. Throat, and Facial Plastic Surgery Group, New Haven, Conn.; the Section of Otolaryngology, Yale University School of Medicine, New Haven; and the Section of Otolaryngology, Hospital of St. Raphael, New Haven.