Bone Exostosis: Difference between revisions

From Face, Mouth and Jaw
Jump to navigation Jump to search
No edit summary
 
(17 intermediate revisions by the same user not shown)
Line 1: Line 1:
[[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 33: Line 36:
** Usually adjacent to premolars and above the mylohyoid attachment
** Usually adjacent to premolars and above the mylohyoid attachment
** If very large can interfere with tongue movement
** If very large can interfere with tongue movement
** Common presentations:
*** Bilateral solitary > bilateral multiple > unilateral solitary > unilateral multiple
* '''Other sites'''
* '''Other sites'''
** Multiple bone exposes can also affect the buccal aspect of maxilla or mandible
** Multiple bone exposes can also affect the buccal aspect of maxilla or mandible
==Differential Diagnosis==
* Differential Diagnosis


==Aetiology and Pathogenesis==
==Aetiology and Pathogenesis==
Line 48: Line 49:
** Hereditary (autosomal dominant inheritance has been described in some)
** Hereditary (autosomal dominant inheritance has been described in some)
** Masticatory hyperfunction
** 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==


===Laboratory Investigations===
===Imaging===
===Imaging===


Line 58: Line 62:
* In large tori - the spongy layer in the middle appears less dense than the cortical bone
* In large tori - the spongy layer in the middle appears less dense than the cortical bone


===Other===
===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==


* 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==


* 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==


*Follow-up
* None needed


==References==
==References==
Line 76: Line 94:
<references />
<references />


[[Category:]]
[[Category:Oral Pathology]]

Latest revision as of 10:59, 15 January 2022

Mandibular tori
Palatal torus
  • 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:
      1. Nasal compact layer - same thickness irrespective of size of tori ∴ confirming that development occurs by downward growth (nasal floor always remains flat)
      2. Middle spongy layer - may not be seen in smaller tori
      3. Oral compact layer
  • 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]