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Dx: Torus Palatinus

KEY FACTS

Terminology Synonym: Palatal torus Definition: Exophytic proliferation of normal cortical & cancellous bone in midline of hard palate Imaging Size varies from very small nodule to large multilobed protuberances Flat, nodular, multilobed, or spindle-shaped Intraoral Imaging: Well-defined radiopacities, which may superimpose on maxillary sinus in posterior periapical views CBCT: Exophytic high-density areas in middle of hard palate Top Differential Diagnoses Exostoses
Osteoma

Pathology Genetic with overlay of environmental influences: Parafunctional activity Possibly X-linked, accounting for higher incidence in women Associated with buccal and palatal exostoses & mandibular tori Clinical Issues
Females > males

More common in ethnic groups: Mongols and Eskimos Prognosis excellent; no malignant potential Tori are removed when consistently traumatized or interfere with function Diagnostic Checklist Consider: Osteoma/Gardner syndrome if not in expected location for tori
TERMINOLOGY

Abbreviations Torus palatinus (TP) Synonyms Palatal torus Definitions Exophytic proliferation of normal cortical and cancellous bone in midline of hard palate
IMAGING

General Features Location: Midline of hard palate Size: Varies from very small nodule to large multilobed protuberances Morphology: Flat, nodular, multilobed, or spindle-shaped Radiographic Findings Intraoral plain film: Well-defined radiopacities, which may superimpose on maxillary sinus in posterior periapical

views CT Findings CBCT: Exophytic high-density areas in middle of hard palate


DIFFERENTIAL DIAGNOSIS

Exostoses Plain film: Well-defined radiopacity usually more cervical than torus palatinus CBCT: Exophytic bony protuberances on buccal or palatal alveolar processes
Osteoma

Exophytic nodules more common on ramus and inferior border of mandible May be multiple: Gardner syndrome
PATHOLOGY

General Features Etiology: Genetic with overlay of environmental influences: Parafunctional activity Genetics: Possibly X-linked, accounting for higher incidence in women Associated abnormalities Buccal and palatal exostoses Mandibular tori Microscopic Features Dense cancellous bone with rim of cortical bone of various thickness
CLINICAL ISSUES

Presentation Most common signs/symptoms: Asymptomatic unless traumatized Other signs/symptoms Large tori may cause difficulty eating and speaking Large tori may be chronically traumatized during mastication Demographics Age: Usually develops before age 30 Gender: Females > males Epidemiology More common in ethnic groups: Mongols and Eskimos Studies have shown that postmenopausal women with large TP have higher mean bone density than their peers and much younger women Natural History & Prognosis May slowly increase in size Prognosis excellent; no malignant potential Treatment No treatment required Tori are removed when consistently traumatized or interfere with function or fabrication of prostheses to replace missing teeth
DIAGNOSTIC CHECKLIST

Consider

Osteoma/Gardner syndrome if not in expected location for tori