Maxillary Torus

Maxillary tori consist of bony exostosis formation in the area of the

palate.
The origin of maxillary tori is unclear.
Tori are found in 20% of the female population, which is
approximately twice the prevalence rate in males.
Tori may have multiple shapes and configurations, ranging from a
single smooth elevation to a multiloculated pedunculated bony mass.

James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
 Tori present few problems when the maxillary dentition is present
and only occasionally interfere with speech or become ulcerated from
frequent trauma to the palate.
However, when the loss of teeth necessitates full or partial denture
construction, tori often interfere with proper design and function of
the prosthesis.

James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
CAUSES FOR CARRYING OUT EXERESIS OF THE TORUS
Disturbances of phonation
Limitation of masticatory mechanics
Sensitivity due to the thin mucosa layer
Traumatic inflammation
Ulcer of a traumatic origin
Retention of food remains
Esthetic reasons
Prosthetic instability
Patients with cancerophobia
Prosthetic treatment
Source of autogenous cortical bone for grafts
A. Garca et al. -Current Status of the Torus Palatinus and Torus Mandibularis
SURGICAL COMPLICATIONS OF THE TORUS
Perforation of the nasal cavities
Secondary anesthesia due to palatine nerve damage
Bone necrosis due to poor refrigeration during surgical drilling
Hemorrhage due to section of palatine arteries
Dilaceration of the palatine mucosa
Fracture of the palatine bone

A. Garca et al. -Current Status of the Torus Palatinus and Torus Mandibularis
POST-OPERATIVE COMPLICATIONS OF THE TORUS

Hematoma
Edema
Opening of a suture
Infection
Bone and mucosal necrosis
Neuralgia
Poor scarring

A. Garca et al. -Current Status of the Torus Palatinus and Torus Mandibularis
Steps in the Removal of Maxillary Torus
1. Typical appearance of maxillary torus.

2. Mid-line incision with anteroposterior

oblique releasing incisions.

3. Mucoperiosteal flaps retracted with

silk sutures to improve access to all
areas of torus. Removal of palatal torus.
James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
4. Sectioning of torus using fissure
bur

5. Small osteotome used to remove

sections of torus.

James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
6. Large bone bur
used to produce the final desired
contour.

7. Soft tissue closure.

James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
Case Report
Surgical management of palatine Torus - case series

Thas Sumie Nozu Imada, Kellen Cristine Tjioe, Marcelo Bonifcio da Silva Sampieri, Jos Endrigo Tinoco-
Araujo, Izabel Regina Fischer Rubira-Bullen, Paulo Srgio da Silva Santos ,Eduardo Sanches Gonales
Biographic Data

40 yrs old Caucasian woman

Medical Condition
Medical records were not contributory to the Maxillary Torus
Dental History
Frequent trauma of palatal mucosa during mastication, aesthetic
complaint and discomfort caused by the trauma of her tongue in this
area.
Oral examination revealed a nodular and hard swelling covered by
healthy mucosa at the midline of the hard palate extending from the
height of the first molars to the middle of the third ones, with an
approximated dimension of 2 cm
Laboratory Results
Microscopical analysis of the removed specimen confirmed the
diagnosis of Torus palatinus
Treatment
Surgical removal of the exostosis under local anesthesia (articaine 4%
with epinephrine 1:100.000) was performed.
A single "Y" incision was performed to expose the bone, followed by
segmental osteotomy under plentiful irrigation, removal of bone
fragments with chisel, nylon sutures, and compression.
A. Single Y incision, B. Trans-operatory view of the segmental osteotomy, C. View of the hard palate after the
surgical removal of the palatine torus, D. Seven-days post-operatory
Post Operative
Four months later, the patient did not experience any sign of
recurrence.
Subjective : Frequent trauma of palatal mucosa during mastication,
aesthetic complaint and discomfort caused by the trauma of her
tongue in this area.

Objective : Medical Condition is normal.

Assessment : Diagnosis : Maxillary Torus

Planning : After four months the patient did not experience any sign of
recurrence. There is a little chance for it to recur.
Mandibular Tori
 Mandibular tori are bony protuberances on the lingual aspect of the
mandible that usually occur in the premolar area.
The origins of this bony exostosis are uncertain, and the growths may
slowly increase in size.
Occasionally, extremely large tori interfere with normal speech or
tongue function during eating, but these tori rarely require removal
when teeth are present.
After the removal of lower teeth and before the construction of
partial or complete dentures, it may be necessary to remove
mandibular tori to facilitate denture construction.
Steps in Removal of Mandibular Tori

a. Exposure of torus.

James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
Steps in Removal of Mandibular Tori

b. Fissure bur and handpiece used to

create small trough between mandibular
ridge and torus.

James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
Steps in Removal of Mandibular Tori

c. Use of small osteotome to complete

removal of torus from the mandible.

James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
Steps in Removal of Mandibular Tori

d. Use of bone bur and bone file to

eliminate minor irregularities.
Removal of mandibular tori.

James R. Hupp, Myron R. Tucker, Edward Ellis III - Contemporary aOral and Maxillofacial Surgery
Case Report
Surgical removal of mandibular tori and its use as an
autogenous graft

Khushboo Rastogi, Santosh Kumar Verma, Rajarshi Bhushan

Biographic Data

47-year-old man
Chief Complaint

Bleeding from gums since 1.5 years and pathological drifting of teeth
since 8 months.
Medical Condition
No medical history
Dental History

Intraoral examination
revealed that the
gingiva was bluish red
in colour, swollen and
bleeds upon probing
with generalised grade
I and grade II mobility
of teeth, pocket
formation and existing
bilateral mandibular
tori.
Dental History

There were missing

35,36 for which the
patient wanted
removable prosthesis.

The exostosis extended

bilaterally from canine
till second premolar on
both the sides. The
swelling was covered
with a thin, intact
mucosa with normal
colour. It was non-tender
and hard in consistency
upon palpation.
Laboratory Result
No laboratory result
Treatment

A full mucoperiosteal flap

was raised under local
anaesthesia from the lower
left side of the canine till
the second molar and the
exostosis was surgically
removed with chisel and
mallet and the flap was
sutured (Figure 2.)

Figure 2 Presurgical.
Treatment
The patient was asked to
revisit after 1 week for
suture removal (Figure 3.)

Figure 3 Left postoperative.

Treatment
A second surgery was
performed on the right
side and the full thickness
flap was raised under
local anaesthesia
extending from the canine
till the second premolar
of the right side.
The flap was raised on the
buccal side as well as
there was bone loss
evident on radiograph Figure 4 Right preoperative.
(Figure 4-7)
Treatment
A second surgery was
performed on the right
side and the full thickness
flap was raised under
local anaesthesia
extending from the canine
till the second premolar
of the right side.
The flap was raised on the
buccal side as well as
there was bone loss
evident on radiograph Figure 5 Incision.
(Figure 4-7)
Treatment
A second surgery was
performed on the right
side and the full thickness
flap was raised under
local anaesthesia
extending from the canine
till the second premolar
of the right side.
The flap was raised on the
buccal side as well as
there was bone loss
evident on radiograph Figure 6 After incision.
(Figure 4-7)
Treatment
A second surgery was
performed on the right
side and the full thickness
flap was raised under
local anaesthesia
extending from the canine
till the second premolar
of the right side.
The flap was raised on the
buccal side as well as
there was bone loss
evident on radiograph Figure 7 Flap reflection.
(Figure 4-7)
Treatment
Lingually, the flap was
raised and extended up to
the exostosis (figure 8).
Exostosis was removed
with the surgical chisel
and bone mallet (figures 9
and 10).

Figure 8 Mandibular tori reflection.

Treatment
Exostosis was removed with the surgical chisel and bone mallet
(figures 9 and 10).
Treatment
Autogenous bone graft
was placed at the
required site and sutures
were placed (figures 11
and 12).

Figure 11 Graft placement.

Treatment

Coe-pak was placed

(figure 13).

Figure 13 Coe-pak placement.

Treatment

The patient was called

after 10 days for a follow-
up (figure 14).

Figure 14 Postoperative after 10 days.

Post-operative Treatment
The patient returned 10 days after surgery for suture removal and to
get the healing checked.

Coe-pak was removed followed with sutures.

There was minimal inflammation, and the patient indicated that he

had minimal discomfort after surgery and that the area felt normal 3
days after surgery.
 Subjective: Patient cant be able to wear denture due to existing
mandibular tori.

Objective: Medical Condition is normal.

Assessment: Diagnosis: Mandibular Tori

Planning: A follow-up appointment was scheduled at 4 weeks after

surgery to check the site. The surgical site 4 weeks after surgery
showed lack of inflammation and complete healing.