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Neuroradiology Case of the Week

Case 226

Devang Butani, MD, and P-L Westesson, MD, PhD, DDS

Clinical Presentation: An 82-year-old patient with mental status changes and left ptosis of unknown duration.

Imaging Findings: Abnormal ossification is noted in the hard palate.  The ossification has well corticated margins.  No apparent mass effect is seen.

Diagnosis: Torus palatinus

Discussion: Torus palatinus is a bony growth on the palate. Palatal tori are usually present on the midline of the hard palate. Most palatal tori are less than 2 cm in diameter, but their size can change throughout life. The 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 populations, and twice more common in females. 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. 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.

Differential diagnoses:

• Osteochondroma
• Osteomas
• Gardner syndrome, with multiple osteomas.

References:

1. Neville BW, Damm D, Allen C, Bouquot J. Oral & Maxillofacial Pathology, 2nd ed. 2002. Page 20. ISBN 0-7216-9003-3.
2. Tori Mandibular, Maxillary, and Palatal. Study guide for Oral Pathology students at the University of Oklahoma College of Dentistry.
3. http://en.wikipedia.org/wiki/Torus_palatinus