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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.
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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.
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- 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
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- 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
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- 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).
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