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PATIENT STORY

An elderly woman is in the office for a physical examination. While looking in her mouth, you see a torus at the midline on the hard palate (Figure 35-1). She states that she has had this for her whole adult life and it does not bother her. You explain to her that it is a torus palatinus and that nothing needs to be done. She is pleased to know the name of this lump and even happier to know that it is not harmful.

FIGURE 35-1

Torus palatinus in a 67-year-old man. The patient was asymptomatic and this was an incidental finding. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Torus palatinus is a benign bony exostosis (bony growth) occurring in the midline of the hard palate. Torus mandibularis often presents as multiple benign bony exostoses on the floor of the mouth. Two less common tori are the torus maxillaris, located near the upper premolars and torus auditivus, usually located on the floor of the external acoustic meatus.1

EPIDEMIOLOGY

  • Most common bony maxillofacial exostosis, unclear origin.

  • Usually in adults older than 30 years of age.

  • Prevalence of torus palatinus ranges from 9.5% to 26.9%; among ethnic groups, the range is wider (0.9% in Vietnamese to 33.8% among African Americans).2 Prevalence of torus mandibularis is about 6%.1

  • More common in women than men for torus palatinus; the reverse is true for torus mandibularis.1

  • Some populations seem to be more predisposed (e.g., Middle Eastern).3

  • An autosomal dominant inheritance is postulated for the oral tori.1

DIAGNOSIS

CLINICAL FEATURES

  • Hard lump protruding from the hard palate into the mouth covered with normal mucous membrane (Figure 35-2).

  • Small size (<2 mm) appear most frequent (70% to 91%).2

  • Shapes include flat, nodular, lobular, or spindle-shaped; nodular appear most common.2

FIGURE 35-2

Torus mandibularis seen under the tongue caused by bony exostoses. Note these are bilateral and appear similar to a torus palatinus. Although this patient had multiple untreated dental problems, the tori were asymptomatic and this was an incidental finding. (Reproduced with permission from Richard P. Usatine, MD.)

TYPICAL DISTRIBUTION

  • Midline hard palate.

DIFFERENTIAL DIAGNOSIS

  • Torus mandibularis is also a bony exostosis but is found under the tongue. These appear similar to a torus palatinus but are usually bilateral (80%) rather than midline (see Figure 35-2).

  • Squamous cell carcinoma is not as hard and the mucous membranes are usually ulcerated. Mucous membranes are normal in appearance with torus palatinus unless traumatized.

  • Adenoid cystic carcinoma is a rare ...

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