The hard palate is the bony partition separating the nasal and oral cavities. Bone loss does not allow separation of the oral and nasal cavities. The interaction between the tongue and the hard palate is essential in the formation of speech and loss of part of this bone can result in impairment of eating and speech. Loss of part of the hard palate allows food to enter the nasopharynx and can cause a speech impediment.

Causes of the conditions could be trauma or disease such as infection, cysts, cancer or other tumors. Tobacco or smokeless tobacco may cause malignant oral and palate lesions.

There is a lack of separation between the nasal and oral cavities and their secretions. Often there are multiple missing teeth when a significant portion of the palate is lost. Speech may be adversely affected; there may be a backward flow of secretions from the mouth up to the nose. Nutrition may be affected, depending upon what can be eaten.

Oral examination, biopsy of suspected lesions, x-rays, and computed tomography (CT) scan would give evidence of the deformities.

Construction of palatal obturator or other maxillofacial appliances are parts of the treatment. Reconstructive surgery in the form of bone grafts or soft tissue procedures or both may be needed.

Speech therapy may be needed following a loss of the hard palate because the voice develops a nasal sound. There may be nutritional deficits due to eating difficulties.

• None.

• For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography

• Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunction, and other impairments under the appropriate diagnostic code and combine under 38 CFR 4.25 for each separately rated condition.