PMC7490980_01
Nodular exophytic mass localized in hard palate presenting with solid consistency, fixed and sessile base from anterior region towards soft palate.
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The lesion measured approximately 5 cm in the anteroposterior direction, 4 cm and 2.5 in the transversal plane, in the posterior and anterior region of the hard palate, respectively (Fig. 1).
PMC7490980_02
Imaging analysis with A) panoramic radiography (orthopantomography), B) 3D Reconstruction and C) Computed Tomography (CT) sagittal section showed the size, extension and length of TP.
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Relative to imaging assessment, in the initial panoramic radiograph, a well-defined radiopaque area located posterior to the maxillary central incisors was observed (Fig. 2A). Finally, the sagittal sections showed a large amount of bone tissue, with a thickness of approximately 3 and 4 mm, with few areas surrounded by lamellar bone (Fig. 2B). In addition, the following features were confirmed: the protuberance was fixed and well-defined within a sessile base, and showed a slight subdivision in the anterior region, closer to the nasopalatine duct (Fig. 2C).
A) Histopathological assessment showed cortical bone, isolated Haversian ducts and absence of cancellous bone; B) 3D scan prints after technique performed.
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Torus Palatinus (TP) as shown in Fig. 3A. Thus, surgical excision was chosen, with surgical pre-planning based on the 3D scan printing (Fig. 3B).
Conservative surgical management of TP by ostectomy using piezoelectric instruments was performed, concluding with primary wound closure.
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Finally, the excess covering mucosa was removed (approximately 2 cm), and primary closure of the surgical bed was performed with simple sutures (Fig. 4).
Wound appearance fifteen days after surgical removal without signs of infection and higher level of surrounding granulated tissue.
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In the immediate postoperative period, antibiotic, anti-inflammatory and analgesic therapy was indicated, and the suture was removed 15 days after the procedure, without dehiscence or signs of inflammation, but with abundant granulation tissue (Fig. 5).