Surgical removal:
Torus palatinus can be removed either under local / general anesthesia. If the surgery is tobe performed under local anesthesia the following nerves should be anesthetised using 2 % xylocaine mixed with 1 in 100,000 units adrenaline.
1.
Nasopalatine nerve should be anesthetised as it exits through the anterior palatine foramen
2.
Anterior palatine nerves should be anesthetised through posterior palatine foramen
3.
Anesthetic solution should also be infiltrated over the mass to detach the oral mucosa from the mass
To surgically remove torus mandibularis infiltration anesthesia is used over the mass. Nerve block anesthesia blocking inferior alveolar, mental and lingual nerves can also be used.
Incision:
To remove torus palatinus a double Y incision is preferred. This incision prevents damage to the nasopalatine and anterior palatine blocks of the hard palate. The incision should involve the full thickness of the muco periosteal lining.
Surgery to remove torus mandibularis involve incision over the mandibular ridge. If the incision is made above the torus it provides a good operating field. In rare cases scalloped inter dental incisons can be used.
Fissure burr is used to remove the bony torus. After removal of torus the flap could be found to be redundant and the same may also be trimmed. The flaps may be sutured back in place using absorbable suture material.
Surgical complications of torus palatinus:
1.
Perforation into the nasal cavity
2.
Secondary anesthesia due to damage to palatine nerve
3.
Palatine artery hemorrhage
4.
Laceration of palatine mucosa
5.
Fracture of palatine bone
Surgical complications of torus mandibularis:
1.
Mandibular fracture
2.
Devitalisation of teeth
3.
Injury to salivary ducts
4.
Injury to lingual nerve
5.
Flap laceration
Post op complications:
1.
Hematoma
2.
Wound infection
3.
Flap necrosis
