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An elderly woman is in the office for a physical examination. While looking in her mouth, a torus is seen at the midline on the hard palate (Figure 33-1). 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 33-1

Torus palatinus in a 66-year-old woman. The patient was asymptomatic and this was an incidental finding. (Courtesy of Richard P. Usatine, MD.)

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.

  • Most common bony maxillofacial exostosis, unclear origin.
  • Usually in adults older than 30 years of age.
  • Prevalence ranges from 9.5% to 26.9%; among ethnic groups, the range is wider (0.9% in Vietnamese to 33.8% among African Americans).1
  • More common in women than men.
  • Some populations seem to be more predisposed (e.g., Middle Eastern).2

Clinical Features

  • Hard lump protruding from the hard palate into the mouth covered with normal mucous membrane (Figure 33-2).
  • Small size (<2 mm) appear most frequent (70% to 91%).1
  • Shapes include flat, nodular, lobular, or spindle-shaped; nodular appear most common.1

Figure 33-2

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. (Courtesy of Richard P. Usatine, MD.)

Typical Distribution

  • Midline hard palate.

  • Torus mandibularis is also a bony exostosis but is found under the tongue. These appear similar to a torus palatinus but are usually bilateral rather than midline (Figure 33-2).
  • 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 tumor that can start in a minor salivary gland over the hard palate. Note that this tumor will not be midline as found in the torus palatinus. If a suspected torus is not midline a biopsy is needed to rule out this potentially fatal carcinoma (Figure 33-3).

Figure 33-3

Adenoid cystic carcinoma in a 22-year-old woman. The arrow points to this unilateral tumor that should not be confused with a torus palatinus. ...

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