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CION Cancer Clinics
The hole left in the palate and what closes it | CION Cancer Clinics
Removing part of the upper jaw leaves an opening between your mouth and the nose or sinus above it. Left open, it lets air, food and drink pass through, which affects speech and swallowing. It is closed either with a removable plate called an obturator, or with living tissue moved from elsewhere in the body. This page explains both, and who each suits less well. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is the hole in the palate after maxillectomy?
- What does an open palate affect?
- How is the hole closed over the months after surgery?
- How do a plate and a flap compare?
- Who is each option less suited to?
- What do people often get wrong about the palate?
- What do the words in your notes mean?
- Common questions about the palate after maxillectomy
The short answer
What is the hole in the palate after maxillectomy?
When part of the upper jaw is removed, it leaves an opening between your mouth and the nose or sinus above it. That opening is closed either with a removable plate called an obturator, or with living tissue moved from elsewhere in the body, called a flap.
Why the hole is there
The roof of your mouth, the palate, is also the floor of your nose and sinus. A cancer growing in that bone cannot be removed without taking the bone with it. The size of the hole depends on how much was removed, and it is planned before the operation.
Why closing it matters
An open palate lets air, food and drink pass between the mouth and nose. Closing it lets you speak clearly, swallow without liquid coming out of the nose, and eat by mouth. Both closing methods can do this well. They suit different people.
What decides how big the hole is
A small cancer on the gum may leave only a narrow gap near the teeth. A cancer that fills the sinus can leave a much larger space that runs up towards the eye and back towards the throat. Your surgeon can usually tell you before the operation roughly how large the opening will be, and which teeth will go with it. Ask to be shown on a picture or a model of the skull, so the family understands too.
The words defect and fistula on your notes both describe this opening. They do not mean something has gone wrong.Before it is sealed
What does an open palate affect?
These effects are strongest when the hole is uncovered, for example when the plate is out for cleaning.
Speech
Air escapes into the nose as you talk. Your voice sounds nasal and some sounds become hard to understand, especially on the phone. Speech usually improves as soon as the opening is sealed again.
Swallowing
Liquids and soft food can pass up into the nose and come out of the nostrils. Tea and water are usually the hardest.
Chewing
You lose teeth on the operated side, so chewing moves to the other side. Hard or sticky foods need care.
The nose and sinus
The lining of the cavity dries and forms crusts. Rinsing keeps it clean and comfortable.
Often helps
- Salt water rinses as taught by the team
- Steam inhalation, if advised
Not sure whether this applies to you?
Ask an oncologistWhen a plate is used
How is the hole closed over the months after surgery?
In the operating theatre
A surgical obturator, a simple plate made from moulds taken before surgery, is fixed in place over packing. It lets you swallow and speak from the first days.
When the packing comes out
After about a week the packing and first plate are removed. An interim obturator is fitted, which you learn to take out and clean yourself.
While the area heals
The tissue shrinks and changes, especially during radiotherapy. The interim plate is relined and adjusted at several visits so it keeps sealing.
The long-term plate
Once healing has settled, often several months later, a definitive obturator is made. It is lighter, fits closely and can carry replacement teeth.
Side by side
How do a plate and a flap compare?
Obturator (removable plate)
Flap (living tissue)
Shorter operation, no second surgical site
Longer operation, tissue taken from the arm, thigh, leg or back
You can look straight into the cavity to check it
The cavity is covered, so checks rely more on scans
Needs daily removal, cleaning and regular adjustment
Nothing to take out once healed
Works best for smaller holes with teeth left to hold it
Often considered for large holes or when few teeth remain
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Choosing between them
Who is each option less suited to?
Neither method is right for everyone. Your surgeon and prosthodontist, the dentist who makes plates, weigh several things together, and the choice is made with you.
When a plate may not suit
A plate is harder to hold in place when there are few or no upper teeth left, when the hole is very large, or when the jaw is stiff and hard to open after radiotherapy. People with weak hands or poor eyesight may find daily removal and cleaning difficult without help at home.
When a flap may not suit
A flap means a longer anaesthetic and a second wound. It may not be offered when heart or lung health makes long surgery unsafe, or when the blood vessels needed to join the flap are poor. Some teams also prefer to see directly into the cavity for a while after surgery.
Both are sometimes used
A flap can close part of the hole, with a small plate for the rest, or carry dental implants later. Some people start with a plate and move to a flap after radiotherapy, or the other way round. Ask whether your plan leaves room to change later if the first choice does not suit you.
Commonly believed
What do people often get wrong about the palate?
"The hole will close up on its own in time."
A hole left by removing bone does not grow back. It stays open unless a plate or a flap seals it. Small gaps from other causes sometimes heal, but not after a maxillectomy.
"A flap is always better because nothing comes out."
A flap suits some people well and others poorly. A plate can give excellent speech and eating, and lets the team see into the cavity. Neither is the better choice for everyone.
"Food coming out of the nose means the operation failed."
It usually means the seal is not quite right, often because the tissue has shrunk. The plate can be adjusted or relined. Tell the team rather than cutting back on food and drink.
"The first plate is the one you keep for life."
Most people go through more than one plate. The mouth keeps changing for months, and the plate is remade to follow it.
On your notes
What do the words in your notes mean?
- Palatal defect
- The opening in the roof of the mouth left after the bone is removed.
- Oroantral or oronasal fistula
- An opening between the mouth and the sinus, or the mouth and the nose.
- Obturator
- A removable plate with a raised part that fits up into the opening and seals it.
- Free flap
- Tissue moved from another part of the body, with its blood vessels joined in the neck under a microscope.
- Prosthodontist
- A dentist trained to make plates, artificial teeth and facial prostheses.
Questions we are asked
Common questions about the palate after maxillectomy
Will I be able to talk normally with the hole closed?
Most people speak clearly enough to be understood once the hole is sealed well. Speech often sounds a little different, especially when tired. If your voice becomes nasal again, the seal may need adjusting. A speech therapist can help with the sounds you find hardest.
Can I choose between a plate and a flap?
You can ask, and your preference matters. The choice also depends on the size of the hole, the teeth you have left, your general health and whether radiotherapy is planned. Ask your surgeon to explain which options are realistic for you and why.
Why do water and tea come out of my nose?
Liquids find the smallest gap in the seal. Early on, the tissue is still changing shape, so a plate that fitted last week may leak today. Sip slowly and tilt your chin down a little. Ask for the plate to be checked rather than drinking less.
Is the hole painful?
The healed cavity is not usually painful. The early weeks are sore, and radiotherapy can make the lining tender again for a while. A plate that rubs can cause sore spots. Tell the prosthodontist, because an adjustment usually settles it quickly.
Can dental implants help hold a plate?
Sometimes. Implants placed in remaining bone, or in bone carried in a flap, can hold a plate or artificial teeth more firmly. Not everyone is suitable, especially after radiotherapy to that area. Ask your centre whether it is an option and when it could be considered.
Does radiotherapy change the hole?
It can. Radiotherapy makes tissue tighter and drier over time, and the jaw may become harder to open. The plate often needs relining during and after treatment. Jaw exercises taught by your therapist help keep the mouth opening.
What if the flap does not take?
Occasionally the blood supply to a flap fails, usually in the first days. The team watches it closely for this. If it happens, another operation may be needed, or the hole may be closed with a plate instead. Ask your surgeon how they monitor the flap.
Who pays for the plate?
The operation is often covered by Aarogyasri, CGHS, ECHS, EHS or cashless insurance. Later plates, relines and dental work may be covered differently. Call the helpline with your card details and ask about the plates as well as the surgery.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
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Sources
- Cancer Research UK — Surgery for nasal and sinus cancer
- Cancer Research UK — Surgery for mouth cancer
- National Cancer Institute — Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ) - Patient Version
- Macmillan Cancer Support — Head and neck cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Obturators: The Removable Plate That Seals the PalateHow the plate is made and fittedFlap Reconstruction vs ObturatorA closer look at the choice between the twoNasal Regurgitation of Food and LiquidsWhat to do when food or drink comes out of the noseSpeech After MaxillectomyGetting your voice back after the palate is sealed
Talk to us
Questions about how the palate will be closed?
Tell us what has been planned so far and we will help you reach the right head and neck surgical specialist. One helpline serves every CION centre.