Torus Palatinus

Interesting case of Torus Palatinus

Case presentation:

complaints:

Swelling over the hard palate area on the left side - 15 years

History:

No history of pain over the swelling.
Swelling progressively increased in size during the past 15 years.

On examination:

Globular swelling seen over the left side of hard palate.

Bony hard in nature.

No tenderness.

Clinical photograph of the patient:

torus.JPG

Imaging:

torus_ct.JPG

CT scan axial view showing torus palatinus

Discussion:

The word “tori” is derived from the latin word torus which means “to stand out” / “lump”.

Synonyms: Exostosis of oral cavity, Buccal exostosis.

Definition:

Torus palatinus is a sessile nodule of bone occuring commonly in midline of hard palate. It can also occur over the lingual surface of the maxilla (torus mandibularis). Torus mandibularis is a bony protruberance located on the lingual aspect of the mandible (commonly between the canine and premolar areas). These are bony masses, begining their development during early teens and gradually progresses to adult hood. These masses are slow growing and painless.

These masses are usually self limiting, rarely they may cause periodontal diseases. Periodontal disease is usually caused by the mass forcing food towards the teeth while being chewed instead of away from it. Too large torus may interfere with dentures.

Etiology:

1. Masticatory hyperfunction
2. Genetic factors (common in females)
3. Environmental factors
4. Multifactorial

Age of occurrence:

It is very rare during the first decade of life. Its increase in size occur during the second and third decades of life. According to Bruce etal the average age of presentation of tori is 34. Since there is very little literature available on this subject very little knowledge regarding age of occurrence is available.

Classification:

Oral exostosis was first classified by Haugen. He classified oral cavity exostosis according to their sizes as small, medium and large.

1. Less than 2 mm in their largest diameter – small
2. 2 – 4 mm in their largest diameter – medium
3. More than 4 mm in their largest diameter

According to Haugen majority of oral cavity exostosis belonged to the small and medium categories.

Reichart in his modification of Haugen's classification suggested few changes:

Grade I – Tori up to 3 mm in their largest dimension

Grade II – Tori up to 6 mm in their largest dimension

Grade III – Tori above 6 mm belong to this group

Shapes:

Torus palatinus occur in varying shapes. It can be flat, nodular, lobular or spindle shaped. Small tori are invariable nodular and they are the most common variety encountered. Lobular shapes are pretty rare.

Indications for surgical removal:

1. The mucosa over torus is ulcerated
2. When it interferes with placement of dentures
3. When there is associated periodontal disorder
4. Where torus can be used as graft material
5. Phonatory disturbances
6. Sensitivity of the overlying mucosal layer
7. Disturbances involving masticatory apparatus
8. Esthetic reasons

Treatment:

Is by surgical removal.

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License