Palatal perforation is usually caused by congenital factors or tumors and other factors, and can be seen in nasal malignant granuloma, pharyngeal tuberculosis, and nasopharyngeal carcinoma. The general condition is fair, with weak sweating, poor appetite, often with low fever, a few with high fever, and ineffective treatment with general antibiotics. Local examination shows swelling, erosion and even ulceration of the nasal mucosa, which is granulomatous with grayish-white necrosis on the surface. Most of them involve the inferior turbinate or nasal septum first, which can lead to swelling and bulging of the external part of the nose, and the development of the lesion can cause septal perforation or palatal perforation. So what tests do we need to do for these conditions that cause palatal perforation? Nasal malignant granuloma examination: 1, pathological section examination presents chronic non-specific granulomatous lesions, if there are heterogeneous reticulocytes or nuclear division phase can be diagnosed the disease. 2. Laboratory tests: low white blood cell count, accelerated erythrocyte sedimentation rate; high immunoglobulin level, no specific findings in bacterial, fungal and viral cultures. 3.CT or MR scan can clarify the scope of tumor infiltration, size and invasion of surrounding organs. Malignant granuloma of nasopharynx: The main manifestation of nasopharynx is necrosis, ulcer formation, and mass, and the histology shows a large number of medium-large heterogeneous T lymphocytes infiltrating, with pleomorphic cells, little cytoplasm, polymorphic nucleus, fine chromatin, inconspicuous nucleolus, many cytokinesis, small interstitial blood vessel proliferation, and often tumor cells infiltrating the vessel wall. T-cell lymphoma. Examination of pharyngeal tuberculosis: 1.According to medical history, clinical manifestations and relevant laboratory tests, the primary lesion can be identified. 2. Biopsy can confirm the diagnosis. 3.Imaging examination: chest X-ray, chest CT. 4.Tuberculin test, Mycobacterium tuberculosis interferon release test. Nasopharyngeal cancer examination: 1.After convergence of nasal mucosa, the posterior nostril and nasopharynx can be seen through anterior nasoscope, which can detect the cancer invading or adjacent to nostril. 2.Indirect nasopharyngoscopy is a simple and practical method, which should examine each wall of nasopharynx in turn, paying attention to the posterior wall of nasopharyngeal apex and both sides of pharyngeal fossa, and the corresponding parts of both sides should be observed in comparison, and any asymmetrical submucosal elevation or isolated nodules on both sides should be paid more attention. 3.Fiber nasopharyngoscopy can be performed with 1% ephedrine solution to astringent nasal mucosa expansion of the nasal tract, and then 1% dicaine solution surface anesthesia of the nasal tract, and then the fiber optic mirror will be inserted from the nasal cavity, one side observation, one side forward until the nasopharyngeal cavity, this method is simple, the mirror is well fixed, but the posterior nostril and the parietal anterior wall observation is not satisfactory. 4, neck biopsy on the nasopharyngeal biopsy has failed to confirm the diagnosis of the case can be performed on the neck mass biopsy, generally can be carried out under local anesthesia, the operation should choose the earliest appear hard and solid lymph nodes, and strive to remove the entire envelope, such as excisional biopsy really difficult, can be made at the mass wedge cut biopsy, cut tissue must have a certain depth, and do not squeeze, after the operation field should not be too tight and too close suture.