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torus palantinus

Middle-aged Woman With a Bony Oral Lesion

DAVID EFFRON, MD
Case Western Reserve University

Dr Effron is assistant professor of emergency medicine at Case Western Reserve University, attending physician in the department of emergency medicine at the MetroHealth Medical Center, and consultant emergency physician at the Cleveland Clinic Foundation, all in Cleveland.

Volume 53 - Issue 7 - July 2013

 

A 50-year-old woman presents to your office with a sore throat of 2 days’ duration. She denies any fever, chills, dysphagia, chest pain, or shortness of breath, and she has had no recent ill contacts.

HISTORY

Her past medical history is significant for treated hypertension and hypothyroidism; she is compliant with prescribed medical therapy. She smokes a half pack of cigarettes per day.

torus palatinus

PHYSICAL EXAMINATION

The patient is alert and in no distress. Blood pressure is 138/84 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile. Lung are clear, and heart sounds are normal. Tympanic membranes are unremarkable, and there are no gross dental abnormalities. Tonsils are not inflamed and the throat is moist with a normal voice, although there is some nasal congestion.

You notice a midline mass on the hard palate, which is nontender, has a normal mucosal color, and is nonmobile. Upon further questioning, the patient states that she has felt a mass in her mouth for years but never was concerned enough to ask a physician about its significance.

WHAT’S YOUR DIAGNOSIS?

(Answer on next page)

 

ANSWER: Torus palatinus

Oral lesions can run a gamut of etiologies, including but not limited to the following:

•Infectious (viral, bacterial, and fungal).

•Drug-induced.

•Traumatic.

•Cancerous.

•Dental.

•Autoimmune.

palatinus

Figure – Multiple palatal tori can occur, as seen in another patient.

Some lesions are detected by the patient, but many are identified during routine dental examinations or any examination performed for throat or tongue discomfort. It is important to obtain a history of focal complaints, ie, pain, discomfort, bleeding, foul taste or smell, odontalgia, or dysphagia, as well as systemic complaints, such as fever, chills, rashes, or weight loss; it is also crucial to ask about tobacco and alcohol abuse. The patient’s symptoms as well as the physical examination findings should guide the physician as to the appropriate diagnostic evaluation, including imaging studies, laboratory studies, and referral if necessary.

TORUS PALATINUS: AN OVERVIEW

This patient had torus palatinus, a bony protrusion or exostosis that usually affects the midline of the hard palate or roof of the mouth. These lesions extend symmetrically from the midline and can be lobular, nodular, or spindle-shaped in appearance. They are benign, although they can be locally annoying to the patient, and grow slowly, with an average size of 2 cm. Typically, they are smooth, broad based, and firm to touch, and they have normal overlying mucosal surface. Single lesions are most common, but multiple lesions may be present (Figure). These lesions are more frequently found in females and have a racial predilection for Asians, Native Americans, and Inuit Eskimos. The etiology of these lesions is thought to be genetic.

While the lesions are often detected during early adulthood, many patients are ignorant of their presence until their oral cavity is examined (by a dentist or oral exploration by the patient). The lesions may decrease in size with age as bony resorption occurs.

Lesions may also develop on the mandibular surface and are classified as torus mandibularis. These lesions occur much less frequently then palatal tori (9% to 60%).

Although palatal and mandibular tori are benign, they may cause irritation from local trauma; ulcerations and secondary infection may develop and even bleeding may occur. Their presence may impede the utilization of dentures. Surgical removal is considered the standard treatment for these lesions and involves removal of part of the bony protuberance. ■

FOR MORE INFORMATION:

•Dunlap CL, Barker BF. A Guide to Common Oral Lesions. Department of Oral and Maxillofacial Pathology, University of Missouri–Kansas City School of Dentistry, 2004. Available at: http://dentistry.umkc.edu/practition/assets/OralLesions.pdf. Accessed June 17, 2013.

•Morgan R, Tsang J, Harrington N, Fook L. Survey of hospital doctors’ attitudes and knowledge of oral conditions in older patients. Postgrad Med J. 2001;77:392-394.