Torus Mandibularis and Palatinus: Surgical Removal

Torus mandibularis and torus palatinus are benign bony overgrowths that arise on the lingual surface of the mandible and on the midline of the hard...

Torus mandibularis and torus palatinus are benign bony overgrowths that arise on the lingual surface of the mandible and on the midline of the hard palate respectively. They are among the most common exostoses of the oral cavity, and in the great majority of cases they cause no symptoms and require no treatment. However, when a torus grows large enough to interfere with the placement of a denture, the fabrication of a prosthesis, the function of the tongue, or the maintenance of oral hygiene, its surgical removal becomes necessary. This article explains the nature of these bony growths, the indications for their removal, and the surgical technique that allows a safe and predictable outcome.

What Are the Tori?

A torus is a slow-growing, benign overgrowth of cortical bone, covered by a thin layer of normal mucosa. Torus mandibularis appears as one or more rounded elevations on the lingual aspect of the mandible, most commonly in the premolar region, and it is frequently bilateral. Torus palatinus arises along the midline of the hard palate and can vary from a small, flat prominence to a large, lobulated mass that occupies most of the palatal vault. Both conditions are developmental in origin, and their prevalence varies among populations, with a strong genetic influence.

The growth of a torus is typically very slow, and most tori are discovered incidentally during a routine dental examination rather than because they cause symptoms. The surface is covered by normal mucosa, the growth is hard to palpation, and the radiograph shows a dense, well-defined area of bone without any destructive features. It is important to recognize these characteristic findings, because they distinguish a torus from the much rarer and more serious conditions that can produce an intraoral swelling.

Indications for Removal

Most tori require no treatment, and the decision to remove one is based on function rather than on the presence of the growth itself. The most common indication is interference with the construction or the wearing of a removable prosthesis. A torus palatinus that is large or lobulated prevents the proper seating of an upper denture, because the denture cannot adapt to the uneven surface and the thin mucosa over the torus is poorly suited to bearing occlusal load. Similarly, a torus mandibularis can obstruct the lingual flange of a lower denture and prevent it from seating correctly.

Removal may also be indicated when a torus interferes with speech, when it is repeatedly traumatized by food or by the opposing teeth, when it complicates the placement of an implant or an orthodontic appliance, or when it makes oral hygiene so difficult that gingival inflammation develops around the lingual surfaces of the adjacent teeth. In rare cases, a torus that grows to a very large size may interfere with the movement of the tongue or the swallowing of food. In all these situations, the benefits of removal must be weighed against the small risks of the surgery.

Preoperative Assessment

A full clinical and radiographic assessment is essential before the removal of a torus. The clinician must confirm the diagnosis, define the size and the extent of the growth, and identify its relationship to important anatomical structures. On the mandible, the clinician must consider the position of the mental foramen and the mandibular canal, since the torus can extend close to these structures, and on the palate, the course of the greater palatine neurovascular bundle must be respected. Imaging such as a panoramic radiograph or a cone-beam scan is valuable for large or atypical tori.

The patient's general health must also be assessed. Because the removal of a torus involves the exposure of a large area of bone, the patient must be able to heal normally, and conditions such as uncontrolled diabetes, immunosuppression, or the use of anticoagulant medication require careful consideration and often modification before surgery. The surgeon should also explain the nature of the procedure, the expected recovery, and the possible complications, and obtain informed consent before proceeding.

The Surgical Technique

The removal of a torus is performed under local anesthesia and is usually an outpatient procedure. For a torus palatinus, a midline incision is made over the growth, or a flap is raised, to expose the underlying bone, and a bur is used to reduce the torus to the level of the surrounding palate, removing the overgrowth in small increments while protecting the mucosa with a retractor. For a torus mandibularis, an incision is made along the crest of the ridge or in the lingual sulcus, and a mucoperiosteal flap is elevated to expose the bone.

Once the bone is exposed, the torus is reduced with a large round bur, an osteotome, or a piezoelectric instrument, and the surface is smoothed so that it is flush with the surrounding bone and free of any sharp edges or undercuts. The wound is then irrigated thoroughly, the flap is repositioned, and the incision is closed with interrupted sutures. The removed bone may be sent for histological examination if there is any doubt about the diagnosis, although the clinical and radiographic features are usually characteristic enough to make this unnecessary.

Postoperative Care and Complications

The recovery after torus removal is generally straightforward, although the patient should expect some swelling, discomfort, and, particularly after palatal surgery, a temporary difficulty with eating. The area is kept clean with gentle rinsing, and the diet is soft for the first week. Analgesics control the pain, and the sutures are removed after about a week. Complete healing of the bone surface takes several weeks, and the patient is reviewed to confirm that the site has healed smoothly and that the denture, where indicated, can now be made or seated properly.

Complications are uncommon but include postoperative bleeding, which is usually controlled by pressure, and the development of a hematoma or a wound infection, which is managed with hygiene, drainage if required, and antibiotics. Damage to the mental or palatine nerves is possible but rare when the anatomy is respected, and a small amount of bone necrosis or a delayed healing can occur if the flap is thin or the patient's healing is impaired. With careful planning and technique, the procedure is safe, and the functional benefit for the patient is usually substantial.

Clinical Key Points

Tori are benign, slow-growing bony overgrowths that usually require no treatment.

Removal is indicated when they interfere with dentures, speech, or hygiene.

Torus palatinus sits in the midline of the palate; torus mandibularis on the lingual mandible.

Preoperative imaging identifies the relationship to vital structures.

The torus is reduced with a bur and smoothed flush with the surrounding bone.

Complications are rare when anatomy and healing are carefully assessed.

Conclusion

Torus mandibularis and torus palatinus are common, harmless bony growths that most patients live with for a lifetime without any problem. When they do cause interference, however, their surgical removal is a well-established, safe, and highly effective procedure that restores normal function and allows the patient to wear a prosthesis, speak, and maintain hygiene without difficulty. With careful preoperative assessment, meticulous surgical technique, and appropriate postoperative care, the removal of a torus carries a low risk and a high rate of patient satisfaction, making it a routine and rewarding procedure in oral and maxillofacial surgery.