Because a significant proportion of the population performs consensual fellatio, anecdotal accounts from oral surgeons suggest that palatal lesions consequent to such acts are rarely identified during routine casework, although this may be a result of the rapid resolution of the injuries. Nevertheless, several case reports have documented palatal lesions after fellatio. Areas of pete-chial hemorrhage and confluent bruising have been described on the soft palate and at the junction between the hard and soft palates after consensual fellatio (73-75). These areas of bruising vary from discrete single or bilateral lesions of 1.0-1.5 cm in diameter, located on or either side of the midline (74), to larger bands of bruising that cross the midline (73,75). The bruises are painless and resolve in 7-10 days (73,74), although they may reappear with repeated fellatio (74).
A forensic practitioner may be asked to explain to the court why these bruises occur. Although the precise mechanism is unknown, the following hypotheses have been proffered:
1. Repeated contraction of the palatal muscles: As the penis touches the palatal mucosa, the gag reflex is activated, with resultant contraction of the soft palate and other constrictor muscles of the pharynx. It is suggested that the combination of retching and repeated palatal movements causes rupture of the blood vessels in the highly vascular palatal mucosa (73).
2. Sucking: Sucking on the penis produces a negative intraoral pressure, which is postulated to cause rupture of the blood vessels in the palatal mucosa. This theory is supported by the anecdotal accounts of oral surgeons who found petechial hemorrhages on the palates of children who "made a habit of forceful sucking into a drinking glass" (74).
3. Blunt trauma: Case reports describe palatal bruises subsequent to sexual assaults wherein a digit or digits have been forced into the mouth (76). However, there is no specific evidence to support the hypothesis that direct blunt trauma from a penis can cause palatal bruising.
Erythema and an erosion of the hard palate have also been described after fellatio (74,75), but the reliability of such findings is questionable. Indeed, in one such case, the mucositis was eventually diagnosed as oral candidiasis contracted from direct contact with an infected penis (75).
Other nonsexual causes for similar palatal lesions include infectious mononucleosis; local trauma (e.g., hard food stuffs or ill-fitting dentures); paroxysms of vomiting, coughing, or sneezing; playing a wind instrument; tumors; and bleeding diatheses (77). Therefore, whenever palatal bruising, erythema, or erosions are identified during the examination of a complainant who may have been subjected to fellatio, alternative explanations should be excluded by taking a detailed medical, dental, and social history; conducting a comprehensive general examination; and, where necessary, undertaking relevant special investigations.
Whenever a complaint of nonconsensual fellatio is made, the head and face must be carefully examined because there may be other injuries around the oral cavity that support the allegation, such as bruises on the face and neck or lacerations of the frenula (78).
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