Palatal tori

Roger L. Myers DMD
Southern Georgia Oral Surgery
Hinesville, Ga. and Statesboro, Ga. Offices
www.southerngeorgiaoms.com

Torus palatinus (tori palatinus) is a bony protrusion on the palate. Palatal tori are usually present on the midline of the hard palate.  However, can be diffuse in size and shape which can encompass the palate unilaterally or bilaterally.   Most palatal tori are less than 2 cm in diameter, but their size can change throughout life.  As one ages the palatal tori can enlarge in size and cause associated issues.  Such as speech, swallowing and chewing problems of the oral cavity.
Prevalence of palatal tori ranges from 9% - 60% and are more common than bony growths occurring on the mandible, known as torus mandibularis. Palatal tori are more common in Asian, Native American and Inuit populations, and twice more common in females. In the United States, the prevalence is 20% - 35% of the population with similar findings between blacks and whites.  In my practice, I  have noticed that more African Americans exhibit palatal tori over mandibular tori.  In addition, seems the most prodominate race with this condition.
Although some research suggest palatal tori to be an autosomal dominant trait, it is generally believed that palatal tori are caused by several factors.  They are more common in early adult life and can increase in size. In some older people, the size of the tori may decrease due to bone resorption. It is believed that tori of the lower jaw are the result of local stresses and not solely on genetic influences.
Sometimes, the tori are categorized by their appearance.  Arising as a broad base and a smooth surface, flat tori are located on the midline of the palate and extend symmetrically to either side. Spindle tori have a ridge located at their midline. Nodular tori have multiple bony growths that each have their own base. Lobular tori have multiple bony growths with a common base.
Palatal tori are usually a clinical finding with no treatment necessary.  It is possible for ulcers to form on the area of the tori due to repeated trauma(As seen in the Photo).   Also, the tori may complicate the fabrication of dentures. If removal of the tori is needed, surgery can be done to reduce the amount of bone present.  If surgical intervention is warranted for placement of a denture, one has to be cognizant of the thin nature of the coving tissue.  The palatal tissue covering the tori in very thin and dehiscence after surgery is very common.  Periodic examination and will allow visualization of the tissue granulating in order to establish closure of the wound.  There is no specific time to predict the healing time, but serial evaluations are suggested as the area heals.  Upon completion of wound healing, the area should be inspected for any bony projections or prominences.  These factors alone can inhibit the placement of a denture post-operatively.

CASE STUDY:

Chief Complaint:  "I can't chew without teeth and I need a denture"
PMH:  Heart Murmur, Diabetes Type 2, Kidney Disease, HTN
Meds:  Diovan, Metoprolol, Plavix, Actos
PSHx:  None
ALL:  NKDA

Findings:  Massive palatal tori obstucting patients ability to chew, spaeak and breath.  Bilateral growth with central prominence.
Plan:
1.  Surgically remove palatal tori
2.  IV sedation/LA
3.  losure with 3.0 Vicryl suture
Result:
The procedure was performed under IV sedarion in which multiple incisions for tissue reflection and acess were made.  The palatal tori was removed and primary closure was achieved.  The patient will be seen one week post-operatively and followed until healing is complete.

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