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Torus palatinus.

A 54-year-old woman presented with a firm, painful swelling of the hard palate of 4 years' duration. A clinical diagnosis of maxillary torus without ulceration was made. Computed tomography (CT) was performed for confirmation of torus palatinus and to aid surgical planning. The CT scan demonstrated lobulated bony outgrowths arising from the inferior margin of the hard palate, consistent with torus palatinus. (Fig. 1).

[FIGURE 1 OMITTED]

Discussion

Torus palatinus is a benign, reactive hyperplasia of osseous tissue extending outward from the surface of the bone.'11 It is an intra-oral osseous protruberance of varying size arising along the midline suture of the hard palate.'21 Jainkittivong and Langlais'3 characterised these developmental anomalies as sessile nodular bony masses comprising hyperplastic mature and trabecular bone. The torus can arise from the inner or outer surface of the maxillary bone, and is generally named according to location. [1,4] Torus palatinus presents in approximately 20% of the population and is occult until adulthood. [1,5] The term was coined by Kupffer and Bessel-Hagen in 1879, many years after its first observation.'21

The aetiology of torus palatinus has been researched extensively and is thought to arise from an interplay between genetic and environmental factors and masticatory function. The quasi-continuous genetic or threshold model states that the environmental factors responsible must first reach a threshold level before genetic factors can express themselves in the individual. There is a prevalence in middle-aged females, with racial and ethnic group differences. [2,3]

[FIGURE 2 OMITTED]

The other most common intra-oral exostosis--torus mandibularis--is a bony outgrowth on the lingual surface of the mandible, most frequently in the premolar or canine area. The concurrence of the different forms of tori shows a low prevalence. [2,3] Tori are usually asymptomatic except when complicated by trauma or ulceration. They may also interfere with speech, mastication or fabrication of maxillary dentures.[1,5]

[FIGURE 3 OMITTED]

On panoramic radiographs, small tori palatini are not well demonstrated owing to overlying bony structures; larger tori can be easily detected with a bosselated or multi-lobulated appearance. [1,5] With advances in imaging techniques, multidetector CT including multiplanar imaging, 3D reconstructions and volume rendering techniques, these osseous protuberances of varying size and locations can be diagnosed to facilitate surgical planning. [1]

When treatment is elected, the lesions may be chiselled off the cortex or removed via a burr, cutting through the base of the lesion. Recurrent lesions may occur, but there is no malignant potential. Gardner syndrome should be excluded if patients present with multiple exostoses that are not in the classic torus locations. Intestinal polyposis, desmoids and cutaneous fibromas are other common features of this autosomal dominant syndrome.[5]

Conclusion

This report highlights a case of torus palatinus--a benign bony exostosis arising from the midline of the hard palate. Tori have been well documented and researched for some centuries, they occur currently, and are clinically and radiologically diagnosed and managed.

[1.] DelBalso AM. Lesions of the jaw. Semin Ultrasound CT, MR 1995; 16(6): 487-512. [http://dx.doi.org/10.1016/S0887-2171(06)80022-3]

[2.] Antoniades DZ, Belazi M, Papanayiotou P. Concurrence of torus palatinus with palatal and buccal exostoses. Oral Surg Oral Med Oral Path Oral Radiol Endod 1998; 85: 552-557. [http://dx.doi.org/10.1016/S1079-2104(98)90290-6]

[3.] Jainkittivong A, Langlais RP. Buccal and palatal exostoses: Prevalence and concurrence with tori. Oral Surg Oral Med Oral Path Oral Radiol Endod 2000; 90: 48-53. [http://dx.doi.org/10.1067/moe2000.1059051

[4.] Yonetsu K, Nakamura T. CT of calcifying jaw bone diseases. AJR 2001;177(4):937-943. [http://dx.doi.org/10.2214/ajr177.4.17709371

[5.] Bouquot JE, Muller S, Hiromasa N. Lesions of the oral cavity. In: Gnepp D. Diagnostic Surgical Pathology of the Head and Neck. 2nd ed Amsterdam: Saunders, 2009:191-308.

P Naidoo, MB BCh, FCRad Diag (SA); N Maharaj, MB ChB, FCRad Diag (SA); J Maharajh, MB ChB, FFRad (D) SA, MMed Rad (D); A Y Moosa, MB ChB, FCRad Diag(SA)

Department of Diagnostic Radiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal and King Edward VIII Hospital, Durban, South Africa

Corresponding author: P Naidoo (pumersh@hotmail.com)
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Title Annotation:PICTORIAL INTERLUDE
Author:Naidoo, P.; Maharaj, N.; Maharajh, J.; Moosa, A.Y.
Publication:South African Journal of Radiology
Article Type:Clinical report
Geographic Code:6SOUT
Date:Dec 1, 2013
Words:697
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