The palate is a favorable site of the oral cavity for soft tissue lesions. Palatal perforation is an uncommon clinical condition. It may result from inherited or acquired factors. The acquired causes include infections, malignancy, and certain drug abuse. There are different factors such as diseases process or effects of certain drugs can affect the blood supply leading to tissue ischemia and lesions in the palate. Chronic necrosis of the epithelium lining the palate may destroy the bone to leave a bony sequester that eventually results in palatal perforation. The two most typical symptoms of an oronasal fistula are speech difficulties and nasal regurgitation. For histological study, palatal lesions should be biopsied. It is necessary to get the proper cultures and stains for fungus, bacteria, and mycobacteria. Depending on the underlying etiology, palatal perforations have different treatment options and prognoses. The treatment of palatal perforation and prognosis vary depending on the cause. This review focuses on details of palatal perforation including its etiopathology, classification, clinical features, and its current management.