In the "store and forward" teledermatology modality, there is a transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider in another location (Roman & Jacob, 2015). The construct of the Teledermatology Viewpoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.
TELEDERMATOLOGY READER REPORT1
History
Chief complaint: presenting for diagnosis.
History of present illness
A 65-year-old man presents with an asymptomatic growth in the hard palate that he says "just grew." Prior treatment for condition: none. Prior biopsy: none.
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT
There is one image provided with this consult.
INTERPRETATION OF IMAGES
Lesion A
Findings
The presented lesion shows a well-circumscribed, lobular-appearing, mucosal lined nodule along the palatine raphe. There are no ulcerations noted (Figure 1).
The morphology, location, and history are most consistent with the diagnosis of a submucosal exostosis, namely, a torus palatinus.
RECOMMENDATIONS
Instruct the patient to check that the growth is not compressible and reassure the patient that no intervention is likely necessary.
RECOMMENDED FOLLOW-UP
Seek treatment if exostosis interferes with speech or mastication.
CLINICAL PEARL
Torus palatinus is a painless, benign, mucosal lined, inferiorly projecting exostosis of the hard palate. It is relatively common with a prevalence of 9.5/1,000. Although the affected population is broad, the most classic presentation is in a female adult of Asian descent (Chohayeb & Volpe, 2001; Shah, Sanghavi, Chawda, & Shah, 1992). The osseous overgrowth is believed by many to be largely genetic with autosomal dominant inheritance (Loukas et al., 2013), although there is debate about the multifactorial etiology (Khan, Shah, Ali, & Rasheed, 2016). Only rarely do the tori cause symptoms or require intervention.
Tori typically present in adulthood and can resorb back into the hard palate or continue to grow with time (Neville, Damm, Allen, & Bouquot, 2002). Tori are described as flat when symmetrical around the palatine raphe. Spindle tori are also along the midline but are shaped like a ridge. If a torus has multiple growths and a common base, it is described as multilobulated. If the torus has multiple growths from many bases, it is described as nodular.
Occasionally, tori can cause problems in fitting dentures or even more rarely with speech or mastication. Referral to otolaryngology or oral surgery is rarely necessary. Indications for referral include significant dysphagia or dysphonia (Garcia-Garcia, Martinez-Gonzalez, Gomez-Font, Soto-Rivadeneira, & Oviedo-Roldan, 2010). Although cases exist of maxillary chondrosarcomas presenting as torus palatine, they are exceedingly rare (Brimioulle, Bowles, & Pelser, 2017).
REFERENCES