To learn more about torus palatinus surgery, watch this video:
Dr Kevin Soh describes how a torus palatinus is removed using videos from live surgery and graphics.
3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510
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If you prefer to read, rather than watch the video, here’s the transcript.
0:17 – DEFINITION: In geometry, a torus is a surface that is generated by a circle as it is rotated about an axis that is in the same plane as the circle. A torus is a donut (doughnut) shaped structure. But in medicine, torus refers to a ridge or linear elevation.
0:24 – ANATOMY: The middle part of our face is made up of the maxillary bones. The maxilla forms the front anterior three-quarter of the hard palate (palatine process of maxilla). The palatine bones form the back posterior one-quarter of the hard palate. The incisive foramen is where the incisive nerve and blood vessels pass through. Posterior nasal spine. The inter-maxillary suture line stretches from the incisive foramen to the posterior nasal spine.
0:58 – A torus palatinus arises from the line of union that forms the inter-maxillary suture line. It is a downward extension of the bones that make up the hard palate. A torus palatinus has to satisfy three criteria: 1) A bony growth, 2) that lies on the midline, 3) of the hard palate. We have to distinguish a torus palatinus from other growths on the palate, e.g. necrotizing sialometaplasia (an inflammatory condition of the salivary glands on the palate), cysts of the incisive canal, minor salivary gland cancers (e.g. adenoid cystic carcinoma, mucoepidermoid carcinoma), and other types of cancers (e.g. lymphoma, Kaposi’s sarcoma).
1:12 – INDICATIONS FOR SURGERY: A torus palatinus only needs to be treated when: 1) there is frequent ulceration and pain on the torus, 2) when food gets stuck in the grooves on the sides of the torus, and 3) when it interferes with the fitting of dentures.
1:23 – Case Presentation: A 42 year old woman presents with a large mass on her palate. She wanted surgery because food was getting stuck in the grooves at the sides of the torus, giving rise to bad breath and poor oral hygiene.
1:26 – Surgery video demo: Lignocaine and adrenaline injection to reduce bleeding during surgery. Midline palatal incision made. Palatal mucoperiosteal flaps are elevated to expose the bony torus palatinus. The torus is removed with a drill, using an out-to-in approach. The outer part of the torus is made up of very hard cortical bone. More effort is needed to drill away the hard cortical bone. The good thing is that cortical bone is less vascular (fewer blood vessels). So there is hardly any bleeding in this stage of the surgery. As I get deeper, the torus is made up of soft medullary bone. Soft medullary bone is more vascular (more blood vessels). Surgery at this stage results in more bleeding. Now that I have an idea of the depth of bone removal from doing the left side, the torus removal on the right side should be easier and quicker. Instead of an out-to-in approach as in the left side, I can now do an in-to-out approach in the right side. This means that I drill the soft medullary bone first, and egg-shell the hard cortical bone. The egg-shelled hard cortical bone can now be fractured and removed en-masse. I now flush the area thoroughly to remove all bone chips and fragments. I trim away the excess mucoperiosteal tissue. Finally I close the wound with absorbable sutures. The wound looks ugly now, but in six weeks, the healing will be very impressive.
5:21 – Let’s compare what the torus looks like before surgery, and how the wound looks like six weeks after surgery.