What is the treatment for torus mandibularis?

Treatment of Torus Mandibularis

Torus mandibularis requires no treatment in the vast majority of cases, as these benign bony overgrowths are asymptomatic and should be left undisturbed throughout the patient's lifetime. 1

When to Observe (Most Common Approach)

Observation is the standard management for asymptomatic mandibular tori. The following characteristics support a conservative, non-interventional approach:

• Asymptomatic bony overgrowths that do not interfere with function 2, 1
• Incidental findings on imaging or clinical examination 3
• Stable lesions without progressive growth 1
• No interference with speech, mastication, or tongue position 2

Indications for Surgical Removal

Surgical excision is indicated only when tori cause specific functional problems or complications:

Absolute Indications

• Prosthetic interference: When tori prevent proper fitting or retention of removable partial dentures or complete dentures 4, 1
• Obstruction of salivary ducts: Giant tori causing submandibular duct obstruction and sialadenitis (rare but documented complication) 3
• Speech impairment: Large tori that mechanically interfere with articulation 2, 1
• Mastication difficulties: Tori that obstruct normal chewing function 2
• Tongue position interference: Lesions that restrict normal tongue movement 2

Relative Indications

• Recurrent ulceration of overlying mucosa due to trauma 1
• Patient request for removal when causing significant psychological distress 1
• Interference with planned surgical procedures in the oral cavity 1

Surgical Technique (When Indicated)

The standard surgical approach involves:

• Incision: Intrasulcular lingual incision extending from molar to contralateral molar 4
• Flap elevation: Displacement of mucoperiosteal flap to expose the torus 4
• Bone removal: Careful removal by sculpting grooves in the superior lesion area and chiseling, often removing the torus in separate blocks 4
• Closure: Primary closure of the mucoperiosteal flap 4
• Postoperative period: Typically 30 days before prosthetic treatment can proceed 4

Critical Pitfalls to Avoid

• Never remove asymptomatic tori prophylactically - these benign lesions have an excellent prognosis when left alone 1
• Do not confuse with pathologic lesions - exclude syndromes associated with facial exostoses such as Proteus syndrome or Gardner's syndrome before assuming benign torus 5
• Avoid surgery solely for cosmetic concerns unless there is documented functional impairment 1
• Do not proceed with prosthetic fabrication until adequate healing time (minimum 30 days) has elapsed after surgical removal 4

Special Considerations

Anatomic Context

• Large mandibular tori can create narrow working spaces and difficult retractor positioning during transoral surgical procedures 6
• In patients requiring transoral robotic surgery (TORS) for oropharyngeal cancer, large mandibular tori should be considered as potential contraindications to adequate surgical exposure 6

Clinical Characteristics

• Tori are covered by thin, weakly vascularized mucosa overlying densely cortical bone with low-density marrow 2
• Most commonly observed in middle-aged patients, particularly young males 2, 5
• Etiology involves both genetic and environmental factors, including mandibular anatomy 5