ABSTRACT
This 8-year-old boy was undergoing orthodontia with a palatal expander. He came in with the expander broken and the ecchymosis shown. There was no history of thumb sucking, falling with something in his mouth or other accidental trauma. There was no disclosure of abuse, but the examining dentist was concerned about possible sexual assault and collected specimens for pharyngeal gonorrhea. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig111a.jpg"/>
What does Image 111a show?
What is the possible aetiology of these injuries?254
https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig111b.jpg"/>A large bruise is noted over the hard palate in a pattern similar to the plastic frame of the expander. No active bleeding is noted. The shape of a similar expander is shown in a child without a bruise (Image 111b).
Any palatal bruising should be viewed with suspicion. Palatal expansion is used to correct cross bites and to relieve crowding in the maxillary arch. While petechial hemorrhages of the soft palate have been noted in fellatio, 1 the palatal inflammation is located under the palatal acrylic strap that fractured, most likely during the assault. The child firmly denied being assaulted, and it was only because of his being positive for oral gonorrhea that sexual assault was confirmed.
