Bone Exostosis: Difference between revisions
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[[File:Torus cropped.jpg|thumb|right|250px|Mandibular tori]] | |||
[[File:06-06-06palataltori.jpg|thumb|right|250px|Palatal torus]] | |||
* Nodular swellings of normal bone in the oral cavity | * Nodular swellings of normal bone in the oral cavity | ||
* Also known as tori (torus = singular) | * Also known as tori (torus = singular) | ||
Line 20: | Line 23: | ||
==Clinical Features== | ==Clinical Features== | ||
* | * Firm swellings with normal overlying mucosa | ||
** Whilst mucosa is normal it is usually thin and can have a blanched appearance (sometimes can ulcerate) | |||
* Small-sized lesions → <3mm elevation and <10mm diameter | |||
* Medium-sized lesions → 3-5mm elevation and 10-15mm diameter | |||
* Large-sized lesions → >5mm elevation and >15mm diameter | |||
* Usually only affects one site in an individual | |||
* '''Torus palatinus''' | |||
** Occurs in the midline of the palate (usually in the mid-third) | |||
** Usually symmetrical but if large can also become an irregular rounded mass | |||
* '''Torus mandibularis''' | |||
** Found on the lingual surface of the mandible | |||
** Usually adjacent to premolars and above the mylohyoid attachment | |||
** If very large can interfere with tongue movement | |||
** Common presentations: | |||
*** Bilateral solitary > bilateral multiple > unilateral solitary > unilateral multiple | |||
* '''Other sites''' | |||
** Multiple bone exposes can also affect the buccal aspect of maxilla or mandible | |||
== | ==Aetiology and Pathogenesis== | ||
===Aetiology=== | |||
* Largely unknown | |||
* Some suggestions: | |||
** Hereditary (autosomal dominant inheritance has been described in some) | |||
** Masticatory hyperfunction | |||
* | ==Pathogenesis== | ||
* Also largely unknown | |||
* In palatal tori, there is suggestion of continued activity of the embryonic osteoblasts which pile up at the palatal suture after the median palatal suture junction is completed | |||
==Investigations== | ==Investigations== | ||
===Imaging=== | ===Imaging=== | ||
=== | |||
* Radiographically tori appear as radiopaque masses | |||
* Dense bone ∴ they can obliterate details of the teeth and maxillary sinus in plain film radiographs | |||
* In large tori - the spongy layer in the middle appears less dense than the cortical bone | |||
===Histology=== | |||
* '''Torus palatinus''' | |||
** Cross-sectional analysis of tori palatine demonstrate three layers: | |||
**# ''Nasal compact layer'' - same thickness irrespective of size of tori ∴ confirming that development occurs by downward growth (nasal floor always remains flat) | |||
**# ''Middle spongy layer'' - may not be seen in smaller tori | |||
**# ''Oral compact layer'' | |||
* '''Torus mandibularis''' | |||
** Seen as lamellar periosteal outgrowth of the mandible | |||
==Management== | ==Management== | ||
* | * No active treatment needed | ||
* Patient reassurance | |||
* Removal is sometimes needed if they interfere with function or to facilitate dental prosthesis | |||
* Tori have been described as a source of autogenous bone graft in implant placement<ref>[https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiXr7_Xr7P1AhXEoFwKHcjrCt0QFnoECB0QAQ&url=https%3A%2F%2Fwww.nature.com%2Farticles%2F4801009.pdf%3Forigin%3Dppub&usg=AOvVaw1OJzCOXsqDXUpAY_30Ufx5 Barker D, Walls AW, Meechan JG. Ridge augmentation using mandibular tori. British dental journal. 2001 May;190(9):474-6.]</ref><ref>[https://www.researchgate.net/profile/Scott-Ganz/publication/51345779_Mandibular_tori_as_a_source_for_onlay_bone_graft_augmentation_a_surgical_procedure/links/0fcfd500c78a5c1155000000/Mandibular-tori-as-a-source-for-onlay-bone-graft-augmentation-a-surgical-procedure.pdf Ganz SD. Mandibular tori as a source for onlay bone graft augmentation: a surgical procedure. Pract Periodontics Aesthet Dent. 1997 Nov 1;9(9):973-82.]</ref><ref>[https://c2-preview.prosites.com/229399/wy/docs/Publications/Publication3.pdf Proussaefs P. Clinical and histologic evaluation of the use of mandibular tori as donor site for mandibular block autografts: report of three cases. International Journal of Periodontics & Restorative Dentistry. 2006 Jan 1;26(1).]</ref> | |||
==Prognosis and Complications== | ==Prognosis and Complications== | ||
* | * Benign | ||
* Recurrent ulceration can occur due to thin overlying mucosa | |||
* Large lesions can interfere with function and dental prosthesis | |||
==Follow-up== | ==Follow-up== | ||
* | * None needed | ||
==References== | ==References== | ||
Line 52: | Line 94: | ||
<references /> | <references /> | ||
[[Category:]] | [[Category:Oral Pathology]] |
Latest revision as of 11:59, 15 January 2022
- Nodular swellings of normal bone in the oral cavity
- Also known as tori (torus = singular)
- Common sites:
- Hard palate (torus palatinus)
- Lingual premolar region of the mandible (torus mandibularis)
- Buccal alveolar bone of maxilla or mandible
Epidemiology[edit | edit source]
- Incidence varies between different races[1]
- More common in Inuit, Native American and Asian populations
- Torus palatinus
- More common than mandibular tori
- Incidence - 9-66%
- ♀ > ♂
- Torus mandibularis
- Incidence - 0.5-63.4%
- ♂ > ♀
Clinical Features[edit | edit source]
- Firm swellings with normal overlying mucosa
- Whilst mucosa is normal it is usually thin and can have a blanched appearance (sometimes can ulcerate)
- Small-sized lesions → <3mm elevation and <10mm diameter
- Medium-sized lesions → 3-5mm elevation and 10-15mm diameter
- Large-sized lesions → >5mm elevation and >15mm diameter
- Usually only affects one site in an individual
- Torus palatinus
- Occurs in the midline of the palate (usually in the mid-third)
- Usually symmetrical but if large can also become an irregular rounded mass
- Torus mandibularis
- Found on the lingual surface of the mandible
- Usually adjacent to premolars and above the mylohyoid attachment
- If very large can interfere with tongue movement
- Common presentations:
- Bilateral solitary > bilateral multiple > unilateral solitary > unilateral multiple
- Other sites
- Multiple bone exposes can also affect the buccal aspect of maxilla or mandible
Aetiology and Pathogenesis[edit | edit source]
Aetiology[edit | edit source]
- Largely unknown
- Some suggestions:
- Hereditary (autosomal dominant inheritance has been described in some)
- Masticatory hyperfunction
Pathogenesis[edit | edit source]
- Also largely unknown
- In palatal tori, there is suggestion of continued activity of the embryonic osteoblasts which pile up at the palatal suture after the median palatal suture junction is completed
Investigations[edit | edit source]
Imaging[edit | edit source]
- Radiographically tori appear as radiopaque masses
- Dense bone ∴ they can obliterate details of the teeth and maxillary sinus in plain film radiographs
- In large tori - the spongy layer in the middle appears less dense than the cortical bone
Histology[edit | edit source]
- Torus palatinus
- Cross-sectional analysis of tori palatine demonstrate three layers:
- Nasal compact layer - same thickness irrespective of size of tori ∴ confirming that development occurs by downward growth (nasal floor always remains flat)
- Middle spongy layer - may not be seen in smaller tori
- Oral compact layer
- Cross-sectional analysis of tori palatine demonstrate three layers:
- Torus mandibularis
- Seen as lamellar periosteal outgrowth of the mandible
Management[edit | edit source]
- No active treatment needed
- Patient reassurance
- Removal is sometimes needed if they interfere with function or to facilitate dental prosthesis
- Tori have been described as a source of autogenous bone graft in implant placement[2][3][4]
Prognosis and Complications[edit | edit source]
- Benign
- Recurrent ulceration can occur due to thin overlying mucosa
- Large lesions can interfere with function and dental prosthesis
Follow-up[edit | edit source]
- None needed
References[edit | edit source]
- ↑ Seah YH. Torus palatinus and torus mandibular is: A review of the literature. Australian dental journal. 1995 Oct;40(5):318-21.
- ↑ Barker D, Walls AW, Meechan JG. Ridge augmentation using mandibular tori. British dental journal. 2001 May;190(9):474-6.
- ↑ Ganz SD. Mandibular tori as a source for onlay bone graft augmentation: a surgical procedure. Pract Periodontics Aesthet Dent. 1997 Nov 1;9(9):973-82.
- ↑ Proussaefs P. Clinical and histologic evaluation of the use of mandibular tori as donor site for mandibular block autografts: report of three cases. International Journal of Periodontics & Restorative Dentistry. 2006 Jan 1;26(1).