Maxillary Tori

Maxillary tori consist of bony exostosis formation in the area of the palate, The origin of maxillary tori is unclear. They are found in 20% of the female population, approximately twice. the prevalence in males.? Tori.may have
multiple shapes and configurations, ranging from a single smooth elevation to a multiloculated pedunculated bony , mass. Tori present few problems when the maxillary dentition is present and only occasionally interfere with
speech or become ulcerated from frequent trauma to the palate. However, when the loss of teeth necessitates full or partial denture construction, tori often interfere with :—-~;;.o;~ro~pCe:r..:d~~easnigdnfunction of the prosthesis. Nearly al arg iUa . should be removed before full or partial
denture construction. Smaller tori may often be left, because they do not interfere with prosthetic construction or function, Even small tori  ecessitate removal when they are irregular, extremely, undercut, or in the
area where a posterior palatal seal would be expected: Bilateral greater palatine and incisive blocks and local infiltration provide the necessary anesthesia for tori removal. A linear incision in the midline of the torus
with oblique vertical-releasing incisions at one or both  ends is, generally necessary (Fig. 13-15). 1 ecause the mucosa over this area is extremely thin, care must be taken In reflecting the tissue from the underlying bone,
a particularly difficult task when the tori are multiloculated. Afull palatal flap can sometimes be used for exposure of the’ tori ..Mincision is made’ along the crest of the ridge when the’ patient Is edentulous or a palatal sulcular lnclsion is used when teeth are present. Tissue reflectio n with this type of incision is often verydlfficult if the tori have large undercuts where the bony  exostosis is fused with the palate. ~hen tori with a small  edunculated base are present; an osteotome and mallet may be,used to remove the bony mass. For larger tori it is usually best to section the tori into multiple fragments with a bur in a rotary handpiece. Careful
attention must be paid to the depth of the cuts, to avoid perforation of the floor of the nose. After sectioning, individual portions of the tori can be removed with a mallet and osteotome or a rongeur; then the area can be
smoothed with a large-bone bur. The entire bony projection does .not necessarily require’ removal; but a smooth regular area without undercuts should be created, without extension into the area where a posterior
palatal seal would  e placed. Tissue is readapted by finger pressure and inspected to determine the amount of excess mucosa that may require  emoval. It is important to retain enough tissue to allow a tension-free closure over the entire area of exposed bone. The mucosa  s reapproximated and sutured; an interrupted suture tech-. ni que is often required, because the thih mucosa may not retain sutures well. To prevent hematoma’ formation, some form of pressure dressing,.must be placed
over the area of the palatal vault. A temporary denture or prefabricated splint with a soft liner placed in the , center of the palate to prevent pressure necrosis can also be used to support the thin mucosa and prevent
hematoma formation. The major complications of maxillary tori removal
include postoperative hematoma formation, fracture or perforation of the floor of the nose, and necrosis of the flap. Local care, including vigorous Irngatton, good hygiene, and support with soft tissue conditioners in the
splint or denture  usually provides adequate treatme

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