IS case 447: Torus mandibularis

Nicholas Perry, MD

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-08-30

History

Patient is a 65-year-old male with traumatic fall off a ladder and loss of consciousness.

Findings

CT exam of the cervical spine for trauma demonstrated incidental finding of bilateral bony protrusions at the floor of the oral cavity in the region of the premolars.

Diagnosis

Torus mandibularis

Discussion

Torus mandibularis is a hyperostosis or osseous growth at the mandible along the surface of the oral cavity near the tongue. Mandibular tori (pleural) are found bilaterally in more than 90% of cases. They are typically adjacent to the premolar teeth and superior to the mylohyoid muscle attachment to the mandible. Mandibular tori have a slightly increased male preponderance and are seen commonly in Asian and Inuit populations, though they are found in blacks and whites as well. The prevalence in the U.S. is about 7-10% of the population and they are seen less commonly than a similar pathologic counterpart in the palate known as torus palatinus. The cause of these bony exostoses is not well-understood though a multifactorial explanation is currently accepted. They may be the result of genetic influence or possibly a reaction from local stresses. There is a high association with bruxism, especially in young adult life. The size of tori may vary over time, fluctuating, and, in some cases, significant enlargement can develop with tori touching in the midline mouth. Mandibular tori are typically a clinical finding requiring no treatment. Complications may include ulcer formation due to confined trauma, improper denture alignment, or in the extremely rare instance, obstructive sleep apnea. Removal may be performed surgically to reduce bone protrusion, though recurrence is not uncommon.

References

  1. Neville BW, Damm DD, Allen CM, Bouquot J. Oral & Maxillofacial Pathology, 2nd Ed. Saunders, 2002: 21.
  2. Gonsalves WC, Chi AC, Neville BW. Common oral lesions: Part II. Masses and neoplasia. Am Fam Physician. 2007 Feb 15;75(4):509-12. PMID: 17323711
  3. Rouas A, Midy D. About a mandibular hyperostosis: the torus mandibularis. Surg Radiol Anat. 1997;19(1):41-3. PMID: 9060116

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