Exostosis, Palate, Teledermatology, Torus Palatinus



  1. Markel, Kory
  2. Jacob, Sharon E.


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of a man with an irregularly bordered torus along the palatine raphe protruding inferiorly.


Article Content

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.




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.



Fully satisfactory.



There is one image provided with this consult.



Lesion A


The presented lesion shows a well-circumscribed, lobular-appearing, mucosal lined nodule along the palatine raphe. There are no ulcerations noted (Figure 1).

Figure 1 - Click to enlarge in new windowFIGURE 1. On the inferior surface of the hard palate, there is a multilobulated, mucosal lined, cartilage-capped exostosis protruding inferiorly.

The morphology, location, and history are most consistent with the diagnosis of a submucosal exostosis, namely, a torus palatinus.



Instruct the patient to check that the growth is not compressible and reassure the patient that no intervention is likely necessary.



Seek treatment if exostosis interferes with speech or mastication.



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).




Brimioulle M., Bowles P. F., & Pelser A. (2017). Maxillary chondrosarcoma mimicking torus palatinus. BMJ Case Reports, 2017, bcr-2017-221629. [Context Link]


Chohayeb A. A., & Volpe A. R. (2001). Occurrence of torus palatinus and mandibularis among women of different ethnic groups. American Journal of Dentistry, 14(5), 278-280. [Context Link]


Garcia-Garcia A. S., Martinez-Gonzalez J. M., Gomez-Font R., Soto-Rivadeneira A., & Oviedo-Roldan L. (2010). Current status of the torus palatinus and torus mandibularis. Medicina Oral, Patologia Oral y Cirugia Bucal, 15(2), e353-e360. [Context Link]


Khan S., Shah S. A. H., Ali F., & Rasheed D. (2016). Concurrence of torus palatinus, torus mandibularis and buccal exostosis. Journal of the College of Physicians and Surgeons-Pakistan, 26(11), 111-113. [Context Link]


Loukas M., Hulsberg P., Tubbs R. S., Kapos T., Wartmann C. T., Shaffer K., & Moxham B. J. (2013). The tori of the mouth and ear: A review. Clinical Anatomy, 26, 953-960. doi: [Context Link]


Neville B. W., Damm D., Allen C., & Bouquot J. (2002). Oral & maxillofacial pathology (2nd ed., p. 20). St. Louis, MO: Saunders. [Context Link]


Roman M., & Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal of the Dermatology Nurses' Association, 6(6), 285-287. [Context Link]


Shah D. S., Sanghavi S. J., Chawda J. D., & Shah R. M. (1992). Prevalence of torus palatinus and torus mandibularis in 1000 patients. Indian Journal of Dental Research, 3(4), 107-110. [Context Link]


1The standardized teledermatology reader report format is available for authors on the journal's Web site ( and on the submissions Web site online at [Context Link]