Tori et exostoses multiples : présentation d’un cas et revue de la littérature

Abstract

Résumé -Introduction :Les exostoses et les tori sont des excroissances osseuses bénignes ayant différentes localisations. Les facteurs intervenant dans leur apparition sont encore discutés. Ces excroissances sont asymptomatiques, mais elles peuvent parfois occasionner différentes gênes. De ce fait, leur exérèse n'est que rarement nécessaire. Observation : Il s'agit d'une femme de 58 ans présentant des exostoses et des tori maxillaires et mandibulaires volumineux, associés à un bruxisme aggravé ayant entraîné des attritions occlusales, une baisse de la dimension verticale d'occlusion et des troubles de l'articulation temporo-manbibulaire. Compte tenu du volume des exostoses mandibulaires vestibulaires, une exérèse a été réalisée, associée à la confection d'une plaque de libération occlusale. Commentaires et conclusion : Ce cas interroge sur la part imputable aux surcharges occlusales dans l'apparition d'exostoses. Une revue de la littérature a été réalisée afin de valider cette possible étiologie, de comprendre comment améliorer la prise en charge et éviter leur réapparition.Abstract -Tori and multiple exostoses: a case report and literature review. Introduction: Exostoses and tori are benign bone protuberances occurring in different locations. The factors affecting their appearance are still being discussed. These protuberances are asymptomatic, but they can sometimes cause discomfort. That is why, in some cases, resective surgery is necessary. Clinical observation: We report the case of a 58-year-old woman with massive maxillary and mandibular tori and exostoses. These manifestations were associated with intense bruxism. They resulted in tooth attrition, a decrease in vertical dimension occlusion and temporomandibular joint disorders. In view of the massive vestibular mandibular exostoses, resective surgery was carried out, combined with occlusal splint-making. Discussion and conclusion: This case questioned the connection between occlusal overload and exostoses development. A literature review was carried out to show possible etiologies and to understand how to improve dental care and avoid their reappearance.

Palatal torus: etiology, clinical aspect, and therapeutic strategy

“…The average prevalence of palatal tori seems to be 20-40% with significant topographical disparities. Most authors have observed a predominance of palatal tori in women as well as a larger average size [1][2][3][4].…”

“…Palatal tori are mostly asymptomatic, which is why they usually go unnoticed, and characterized by a fortuitous discovery during a routine examination by the practitioner or by the patients themselves. The diagnosis of palatal torus is clinical, but radiographic and pathological examinations may sometimes be useful [1,2].…”

“…The flat shape is the most common with a symmetrical distribution and a smooth appearance. They are most often covered with a mucosa that appears normal, thin, and hypovascularized, which induces sensitivity during trauma, often causing ulceration or inflammation [1,2,8,9].…”

“…Local anesthesia is indicated in most cases, with large palatal and nasopalatal nerve blocks allowing complete analgesia in the intervention area. However, in cases of large palatal tori or a very posterior localization, general anesthesia may be considered [1][2][3][4][5][6][7][8][9][10][11][12].…”

“…Their discovery usually occurs during a routine clinical examination, sometimes by the patient. Considered as physiological anatomical variations, palatal tori generally do not require any specific treatment [1,2].…”