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A 25-year-old man comes to the physician because of a mass in his mouth. He has had
the lump for many years. He denies weight loss. He was in a motor vehicle accident
several years ago and sustained a concussion of the brain. He does not use tobacco.
alcohol, or illicit drugs. Physical examination shows a nontender 2 x 2-cm mass located
on the hard palate of the mouth that is immobile and has a bony hard consistency.
Which of the following is the most likely cause of this patient's oral finding?

0 A Congenital
o B. Infectious
0 C. Neoplastic
o D. Traumatic
o E. Vascular

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0. ld ; :342 7
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A 25-year-old man comes to the physician because of a mass in his mouth. He has had
the lump for many years. He denies weight loss. He was in a motor vehicle accident
several years ago and sustained a concussion of the brain. He does not use tobacco.
alcohol, or illicit drugs. Physical examination shows a nontender 2 x 2-cm mass located
on the hard palate of the mouth that is immobile and has a bony hard consistency.
Which of the following is the most likely cause of this patient's oral finding?

A Congenital [54%)

B. Infectious [1%)

C. Neoplastic [1 0%)

D. Traumatic [31%]
E. Vascular [4%]

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Explanation: User
This patient presents with a chronic growth on his hard palate consistent with likely torus
palatinus (TP). which is a benign bony growth (i.e.. exostosis) located on the midline
suture of the hard palate. It is thought to be due to both genetic and environmental
factors and is more common in younger patients. women. and Asians. Preceding trauma
does not appear to be associated with TP (Choice 0). Although a TP is usually <2 em in
size. it can increase in size throughout a person's life.
Patients with TP usually say that the lesion has been present for some time and deny
tenderness. The thin epithelium overlying the bony growth tends to ulcerate with normal
trauma of the oral cavity and heal slowly due to a poor vascular supply. Surgery is
indicated for patients in whom the mass becomes symptomatic, interferes with speech or
eating. or causes problems with fitting of dentures later in life.
(Choice B) Infections can occur in the oral cavity but typically do not present as a hard
mass. They also tend to be tender. with surrounding erythema. exudates. discharge. or
drainage.
 E. Vascular [4%)

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Explanation: User
This patient presents with a chronic growth on his hard palate consistent with likely torus
palatinus (TP), which is a benign bony growth (i.e., exostosis) located on the midline
suture of the hard palate. It is thought to be due to both genetic and environmental
factors and is more common in younger patients, women, and Asians. Preceding trauma
does not appear to be associated with TP (Choice 0). Although a TP is usually <2 em in
size, it can increase in size throughout a person's life.
Patients with TP usually say that the lesion has been present for some time and deny
tenderness. The thin epithelium overlying the bony growth tends to ulcerate with normal
trauma of the oral cavity and heal slowly due to a poor vascular supply. Surgery is
indicated for patients in whom the mass becomes symptomatic, interferes with speech or
eating, or causes problems with fitting of dentures later in life.
(Choice S) Infections can occur in the oral cavity but typically do not present as a hard
mass. They also tend to be tender, with surrounding erythema, exudates, discharge, or
drainage.
(Choice C) Neoplasms of the oral cavity can be nontender and immobile but are usually
associated with a history of tobacco or chronic alcohol use. Neoplasms usually tend to
grow in size, without getting smaller, and can cause symptoms with eating or breathing.
This is less likely in this younger patient.

(Choice E) Vascular lesions tend to be mobile and sometimes pulsatile but are not
usually hard and fixed (as seen in this patient).
Educational objective:
In a young individual who presents with a fleshy immobile mass on the midline hard
palate, the most likely diagnosis is torus palatinus. No medical or surgical therapy is
required unless the growth becomes symptomatic or interferes with speech or eating.

References:
1. Current status of the torus palatinus and mandibularis

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