What is torus palatinus?

Torus or tori(plural) means “ stand out” in Latin. It is a slowly growing bony exostosis in the midline of the palate and is covered with a less vascularised mucosa.  Tori may be present in the lower jaw, too. It may be ulcerated due to constant trauma while chewing. They are usually asymptomatic but create trouble during the fabrication of dentures for a person with tori.

Why do tori occur?

Tori occur in the mouth usually due to trauma from heavy chewing forces, Diet, Nutritional deficiencies and due to certain medications like Denosumab.

Why are tori surgically removed?

Tori are surgically removed in the following situations:

1. Difficulty in fabricating or wearing dentures.
2. Difficulty in speech.
3. Ulceration of the overlying mucosa due to constant trauma while chewing.

Immediate postoperative care

As with any surgery, the first 24-48 hours after the surgery are crucial in determining patient comfort and a smooth healing phase. The main parameters to watch for immediately after the surgery are:

1. Pain management: The patient is prescribed non-steroidal anti-inflammatory drugs for pain management. Aspirin is avoided as it interferes with the clotting of blood
2. Bleeding control: It is obtained through gentle, firm pressure applied by biting on a sterile gauze for an hour after the surgery. The gauze may be replaced after that. The bleeding is usually more on the first day but gradually subsides. Heavy bleeding despite all the measures taken should be reported to the surgeon

Swelling and bruising management

1. Cold compresses: Intermittent extraoral ice application is advised for the first 24 hours. No spitting or gargling during this period so as to stabilise the blood clot. The patient is advised against the use of a straw for drinking
2. Warm compresses: These are started after 48 hours to increase the blood circulation at the surgical site
3. Keeping the head elevated while sleeping to avoid excessive swelling

Dietary guidelines

1. First 24-48 hours: foods that do not need to be chewed thoroughly, like yoghurt, risotto, rice gruel, smoothies, milkshakes, ice cream, semolina pudding, soups at room temperature, etc, are favoured
2. Gradual reintroduction to normal foods: about a week after the surgery, softer foods like pasta, scrambled eggs, and completely cooked vegetables can be started to augment the healing process
3. Hydration: It is easy to skip on the fluids to minimise the discomfort, but due care should be taken to have room temperature or cool water and avoid dehydration

Oral hygiene and wound care

Rinsing

The use of chlorhexidine-based mouthwashes or normal saline is encouraged after 48 hours of the surgery to minimise the risk of dislodging the blood clot. Care should be taken not to rinse aggressively.

Brushing and flossing

A soft-bristle brush with a fluoridated toothpaste is advised to take care of oral hygiene. Thread floss can be safely used. Water flosser is to be avoided for a minimum of 15 days, as the pressure from the water jet can cause pain at the surgical site.

Activity and lifestyle modifications

Avoid strenuous activities

Any sort of exercise is to be avoided for the first week so as to avoid exerting pressure on the surgical site.

Smoking and alcohol

To avoid interference with the healing process, both smoking and alcohol is to be stopped for at least 2 weeks after the surgery. The effectiveness of the medications is also compromised due to smoking and alcohol.

Complications and interventions

Even when due precautions are taken while operating as well as during post-surgery care, there may be times when additional intervention may be required. The patient is informed in advance about the possible complications during and after the surgery.

The complications during the surgery include:

Perforation of the nasal cavities- oroantral communication

Bone necrosis due to insufficient cooling while drilling the bone

The post-surgical complications include:

Heavy bleeding

Bleeding beyond the 24-hour mark post-surgery, which is not managed by cold compress and pressure dressing, needs medical intervention.

Pain due to nerve damage or paresthesia

This occurs when the nerve present at the surgical site is compromised or compressed. Appropriate medications are prescribed to counteract the same. Paresthesia may require 6-8 weeks to subside.

Severe pain not relieved by meds

This happens when there is an infection or a dry socket. There is swelling, redness and foul odour from the mouth due to pus formation. There may or may not be a mild fever.

Long-term recovery and follow-up

Follow-up dental visits: 

          Visit 1: The day after the surgery to check for closure and swelling.

          Visit 2: After 1 week, to check for the sutures, wound healing and to check oral. 

Hygiene maintenance and suture removal.

          Visit 3: After 2 weeks, for checking wound healing and oral hygiene.

Expected healing timeline:

          It would take 3-4 weeks for complete healing of the wound, after which the patients can gradually return to normal function.

Conclusion

Removal of the Torus Palatinus is a minor surgery and, when executed well, will heal without any complications. But the post-surgical care is just as important as the surgery itself to ensure a comfortable and painless recovery.