Background:The oral cavity is full of numerous bumps and protrusions, most of which are perfectly normal pieces of anatomy. The hard palate, however, is usually a completely smooth surface short of the small rugae or undulations of its mucosal covering. The actual hard palate is two pieces of perfectly smooth bone that comes together and unites in the middle very early in the formation of the fetus.
This smooth hard palatal surface can be dramatically disrupted by the presence of a hard bony bump or protrusion, commonly known as a palatal torus. These are bony growths that are usually present in the midline of the hard palate. While historically known as a torus, it is more accurately described as a benign osteoma. No one knows why they form or what causes them.For whatever reason they are much more common in women. While often less than 2cms in size, they can continue to growth throughout one’s life.
While palatal tori can be quite small and may appear as just a small and innocuous bump, they can become large. They can grow to the point of occupying much of the hard palatal surface. They can have numerous shapes from round to lobular. If they get big enough and are lobular is shape, they can cause numerous problems including food entrapment, irritation, ulcerations and difficulty with fabricating dentures.
Case Study: This 47 year-old female was undergoing a breast lift procedure and wanted her palatal torus removed at the same time. It was a large hard palatal tumor that measures 3cms in length and 2.5 cms in width. Her main reason for wanting it removed was that food become trapped under its edges on a regular basis, being both an irritant and a hygiene issue.
After her breast lift was completed, a mouth prop was placed and the hard palate infiltrated for hemostasis and after surgery discomfort. Through a midline incision, the palatal mucosa was dissected off of the torus on both sides. With the entire torus exposed, a drill was used to make a midline groove through the thickness of the torus. An osteotome was then used to fracture off the torus in four near equal pieces from the palatal bone. A burr smoothed any remaining raised bony spicules. The mucosa was trimmed of excess tissue and then closed with dissolveable sutures.
The only restriction after surgery was to avoid eating hard foods for a week after surgery. (not that this wouldn’t be obvious when pushing food against the palatal sutures) By three weeks after surgery it was completed healed and all oral functions were resumed. Her palatal surgery healed faster than her breast lift surgery.
Case Highlights:
1) Large palatal tori can cause symptoms, such as food entrapment and a source of irritation, and may necessitate removal.
2) Palatal tori are surgically removed through a midline split approach separating the tori into multiple pieces with an osteotome.
3) Recovery after palatal tori surgery is minimal and they do not recur after their excision.
Dr. Barry Eppley
Indianapolis, Indiana