This is an 82-year-old woman, 45 kg, who consulted for persistent ulceration of the hard palate that caused intense pain, halitosis and difficulty swallowing.
The patient reported the presence of a palatal mass of 60 years of evolution with ulceration in the last year and that in the last two months had had an exotic growth, which increased the discomfort described.
In the clinical examination of the oral cavity, 28 teeth were found in total, with gold fouling and metal-porcelain crowns in molars and premolars.
The periodontium was healthy, without pockets or gingival inflammation.
A mass of firm consistency in the midline was observed in the palate. It measured approximately 5 x 3 x 1.5 cm and occupied almost the entire palatal vault.
The cubic mucosa was very thin and on the left side showed an ulceration area of approximately 7 mm in diameter.
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Due to its clinical appearance, it was considered the differential diagnosis between exposed palatal torus and an osteoma-type tumor lesion, if it originated outside bone tissue, or, in case it originated in the pillar tissues and neoplasia.
For this reason, it was decided to perform surgical resection of the lesion.
The patient signed the informed consent for the surgical procedure to be performed, and authorized the histopathological evaluation and the publication of the clinical case.
Preoperatively, rigorous laboratory tests and general anesthesiology evaluation were performed; the case was managed with periodontal hygiene phase, plaque control bacteria no and reinforcement of oral hygiene measures.
Impression of the upper and lower arches was taken, which were sent to the dental laboratory for making an acrylic palatal plate, which was used as support and protection after the surgical procedure.
The removal of the palatal torus was planned, using aseptic measures and under general anesthesia.
It began with an incision in the palatal raphe throughout the extension of the lesion.
Complete lateral mucoperitic flaps were dissected and raised until reaching the bony palate.
Low speed osteotomy was performed in the anterior and lateral grooves of the lesion with a depth of almost one centimeter.
The osteotomy was continued with a tape, extending the bone surface to the anatomy of the palatine vault with a round bone drill.
Then, blade tissue repair was performed, adapting the flaps and sutured with simple stitches.
Finally, the acrylic plate with Coe-Flex paste was placed over the entire palatal surface, which protected the wound, prevented hemorrhage or hematoma formation, and helped protect the food against healing.
One week later, postoperative control was performed and the plate was placed again with Coe-Flex.
Twelve days later the plate and sutures were removed and the wound was closed.
After six months, a satisfactory clinical evolution was confirmed, with normal appearance of the palate.
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Four fragments of less than 0.6 x 0.3 cm of eroded epithelial tissue, six fragments of 1.5 cm of healthy bone tissue and three fragments of 1 cm of necrotic area were sent for histopathology study.
In the oral mucosa, we found notable reactive hyperplasia of the squamous-cell epithelium with parakeratosis without nuclear atypia in the dermis; in addition, extensive inflammatory infiltrates were associated with chronic lymphoplasmacytic forms, other
Everything contained an important active inflammatory process, possibly due to ulceration due to local trauma.
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Bone tissue showed changes in hyperostosis, consisting of increased thickness of the compact bone layer and trabecular bone density, with no evidence of malignant transformation.
Histopathological diagnosis was made of simple hyperplasia of the mucosa, with chronic inflammatory process and significant acute neighborhood activity, and bone hyperostosis (torus palatinus).
