One of the most common oral surgical procedures we perform is removal of mandibular and maxillary torus and exostosis. Torus and exostosis are bone growth anomalies commonly found on the palate (known as palatine torus), inside of the lower jaw bone (mandibular torus), and outside of either the upper and lower jaw bones (exostosis). They are benign and in most individuals they do not cause any problems. However, they can enlarge gradually over time in response to bone apposition related to direct physical irritation during eating. In some circumstances, patients may develop traumatic ulcers and exposure of bone (known as dehiscence) leading to pain and discomfort.
Removal of torus or exostosis is a relatively minor procedure with minimal discomfort. When removal is indicated, proper diagnosis, planning, and technique should be used for optimal results.
Diagnosis: A CBCT (cone beam CT scan) is required for the assessment of torus / exostosis size, proximity of teeth, anatomy of the jaw bone, and vital structures such as nerves and sinuses.
Technique: This procedure is typically performed by an oral surgeon experienced in management of conditions related to jaw bone.
- Gum tissue reflection: The first step is reflection of the gum tissue over the bony growth. The soft tissue is typically quite thin and requires careful and gentle reflection to avoid tearing which will prolong the healing process.
- Removal of bony mass: It is best to use an ultrasonic piezo-surgical instrument for removal of the bony mass. This provides a gentle and atraumatic approach for bone removal and contouring.
- Closure of gum tissue: Once the torus or exostosis has been removed and recontoured, the gum tissue is repositioned and sutured securely in place with resorbable sutures.
Post-operative healing: Patient should be on liquid / soft diet for 7-10 days, rinse with saline (salt water) every 2 hours for 2 weeks, and take antibiotics for 1 week to prevent infection.
Here are several before and after examples:
Dr. H Ryan Kazemi is a board-certified oral and maxillofacial surgeon in Bethesda, MD