Mandibular tori as an incidental finding in MRI
Identifieur interne : 000136 ( Pmc/Corpus ); précédent : 000135; suivant : 000137Mandibular tori as an incidental finding in MRI
Auteurs : Ivan Platzek ; Marika Schubert ; Dominik Sieron ; Michael LaniadoSource :
- Acta Radiologica Short Reports [ 2047-9816 ] ; 2014.
Abstract
Tori (singular: torus) are among the most common benign jaw lesions. The magnetic resonance imaging (MRI) characteristics have not been reported yet. We present a 72-year-old patient with mandibular tori, which were detected as an incidental finding on MRI and provide an overview of the imaging features of tori.
Url:
DOI: 10.1177/2047981614522790
PubMed: 24778803
PubMed Central: 4001434
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Mandibular tori as an incidental finding in MRI</title><author><name sortKey="Platzek, Ivan" sort="Platzek, Ivan" uniqKey="Platzek I" first="Ivan" last="Platzek">Ivan Platzek</name><affiliation><nlm:aff id="aff1-2047981614522790">Department of Radiology, Dresden University Hospital, Dresden, Germany</nlm:aff></affiliation></author><author><name sortKey="Schubert, Marika" sort="Schubert, Marika" uniqKey="Schubert M" first="Marika" last="Schubert">Marika Schubert</name><affiliation><nlm:aff id="aff2-2047981614522790">Department of Maxillofacial Surgery, Dresden University Hospital, Dresden, Germany</nlm:aff></affiliation></author><author><name sortKey="Sieron, Dominik" sort="Sieron, Dominik" uniqKey="Sieron D" first="Dominik" last="Sieron">Dominik Sieron</name><affiliation><nlm:aff id="aff3-2047981614522790">Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland</nlm:aff></affiliation></author><author><name sortKey="Laniado, Michael" sort="Laniado, Michael" uniqKey="Laniado M" first="Michael" last="Laniado">Michael Laniado</name><affiliation><nlm:aff id="aff1-2047981614522790">Department of Radiology, Dresden University Hospital, Dresden, Germany</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24778803</idno><idno type="pmc">4001434</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001434</idno><idno type="RBID">PMC:4001434</idno><idno type="doi">10.1177/2047981614522790</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000136</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000136</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Mandibular tori as an incidental finding in MRI</title><author><name sortKey="Platzek, Ivan" sort="Platzek, Ivan" uniqKey="Platzek I" first="Ivan" last="Platzek">Ivan Platzek</name><affiliation><nlm:aff id="aff1-2047981614522790">Department of Radiology, Dresden University Hospital, Dresden, Germany</nlm:aff></affiliation></author><author><name sortKey="Schubert, Marika" sort="Schubert, Marika" uniqKey="Schubert M" first="Marika" last="Schubert">Marika Schubert</name><affiliation><nlm:aff id="aff2-2047981614522790">Department of Maxillofacial Surgery, Dresden University Hospital, Dresden, Germany</nlm:aff></affiliation></author><author><name sortKey="Sieron, Dominik" sort="Sieron, Dominik" uniqKey="Sieron D" first="Dominik" last="Sieron">Dominik Sieron</name><affiliation><nlm:aff id="aff3-2047981614522790">Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland</nlm:aff></affiliation></author><author><name sortKey="Laniado, Michael" sort="Laniado, Michael" uniqKey="Laniado M" first="Michael" last="Laniado">Michael Laniado</name><affiliation><nlm:aff id="aff1-2047981614522790">Department of Radiology, Dresden University Hospital, Dresden, Germany</nlm:aff></affiliation></author></analytic><series><title level="j">Acta Radiologica Short Reports</title><idno type="eISSN">2047-9816</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Tori (singular: torus) are among the most common benign jaw lesions. The magnetic resonance imaging (MRI) characteristics have not been reported yet. We present a 72-year-old patient with mandibular tori, which were detected as an incidental finding on MRI and provide an overview of the imaging features of tori.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Garcia Garcia, As" uniqKey="Garcia Garcia A">AS Garcia-Garcia</name></author><author><name sortKey="Martinez Gonzalez, Jm" uniqKey="Martinez Gonzalez J">JM Martinez-Gonzalez</name></author><author><name sortKey="Gomez Font, R" uniqKey="Gomez Font R">R Gomez-Font</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eggen, S" uniqKey="Eggen S">S Eggen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Curran, Ae" uniqKey="Curran A">AE Curran</name></author><author><name sortKey="Pfeffle, Rc" uniqKey="Pfeffle R">RC Pfeffle</name></author><author><name sortKey="Miller, E" uniqKey="Miller E">E Miller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Bayaty, Hf" uniqKey="Al Bayaty H">HF Al-Bayaty</name></author><author><name sortKey="Murti, Pr" uniqKey="Murti P">PR Murti</name></author><author><name sortKey="Matthews, R" uniqKey="Matthews R">R Matthews</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ihunwo, Ao" uniqKey="Ihunwo A">AO Ihunwo</name></author><author><name sortKey="Phukubye, P" uniqKey="Phukubye P">P Phukubye</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jainkittivong, A" uniqKey="Jainkittivong A">A Jainkittivong</name></author><author><name sortKey="Apinhasmit, W" uniqKey="Apinhasmit W">W Apinhasmit</name></author><author><name sortKey="Swasdison, S" uniqKey="Swasdison S">S Swasdison</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Choi, Y" uniqKey="Choi Y">Y Choi</name></author><author><name sortKey="Park, H" uniqKey="Park H">H Park</name></author><author><name sortKey="Lee, Js" uniqKey="Lee J">JS Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baykul, T" uniqKey="Baykul T">T Baykul</name></author><author><name sortKey="Heybeli, N" uniqKey="Heybeli N">N Heybeli</name></author><author><name sortKey="Oyar, O" uniqKey="Oyar O">O Oyar</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Acta Radiol Short Rep</journal-id><journal-id journal-id-type="iso-abbrev">Acta Radiol Short Rep</journal-id><journal-id journal-id-type="publisher-id">ARR</journal-id><journal-id journal-id-type="hwp">sparr</journal-id><journal-title-group><journal-title>Acta Radiologica Short Reports</journal-title></journal-title-group><issn pub-type="epub">2047-9816</issn><publisher><publisher-name>SAGE Publications</publisher-name><publisher-loc>Sage UK: London, England</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24778803</article-id><article-id pub-id-type="pmc">4001434</article-id><article-id pub-id-type="doi">10.1177/2047981614522790</article-id><article-id pub-id-type="publisher-id">10.1177_2047981614522790</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Mandibular tori as an incidental finding in MRI</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Platzek</surname><given-names>Ivan</given-names></name><xref ref-type="aff" rid="aff1-2047981614522790">1</xref></contrib><contrib contrib-type="author"><name><surname>Schubert</surname><given-names>Marika</given-names></name><xref ref-type="aff" rid="aff2-2047981614522790">2</xref></contrib><contrib contrib-type="author"><name><surname>Sieron</surname><given-names>Dominik</given-names></name><xref ref-type="aff" rid="aff3-2047981614522790">3</xref></contrib><contrib contrib-type="author"><name><surname>Laniado</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="aff1-2047981614522790">1</xref></contrib></contrib-group><aff id="aff1-2047981614522790"><label>1</label>Department of Radiology, Dresden University Hospital, Dresden, Germany</aff><aff id="aff2-2047981614522790"><label>2</label>Department of Maxillofacial Surgery, Dresden University Hospital, Dresden, Germany</aff><aff id="aff3-2047981614522790"><label>3</label>Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland</aff><author-notes><corresp id="corresp1-2047981614522790">Ivan Platzek, Department of Radiology, Dresden University Hospital, Fetscherstr. 74, 01307 Dresden, Germany. Email: <email>ivan.platzek@uniklinikum-dresden.de</email></corresp></author-notes><pub-date pub-type="epub"><day>25</day><month>2</month><year>2014</year></pub-date><pub-date pub-type="collection"><month>2</month><year>2014</year></pub-date><volume>3</volume><issue>2</issue><elocation-id>2047981614522790</elocation-id><history><date date-type="received"><day>7</day><month>10</month><year>2013</year></date><date date-type="accepted"><day>25</day><month>12</month><year>2013</year></date></history><permissions><copyright-statement>© The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav</copyright-statement><copyright-year>2014</copyright-year><copyright-holder content-type="society">The Foundation Acta Radiologica</copyright-holder><license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (<ext-link ext-link-type="uri" xlink:href="http://www.creativecommons.org/licenses/by-nc/3.0/">http://www.creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page(<ext-link ext-link-type="uri" xlink:href="http://www.uk.sagepub.com/aboutus/openaccess.htm">http://www.uk.sagepub.com/aboutus/openaccess.htm</ext-link>).</license-p></license></permissions><abstract><p>Tori (singular: torus) are among the most common benign jaw lesions. The magnetic resonance imaging (MRI) characteristics have not been reported yet. We present a 72-year-old patient with mandibular tori, which were detected as an incidental finding on MRI and provide an overview of the imaging features of tori.</p></abstract><kwd-group><kwd>Torus</kwd><kwd>jaw</kwd><kwd>tumor</kwd><kwd>MRI</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>edited-state</meta-name><meta-value>corrected-proof</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec sec-type="intro" id="sec1-2047981614522790"><title>Introduction</title><p>Benign jaw tumors may be of odontogenic or non-odontogenic origin and display a wide spectrum of imaging findings. The need of therapy in benign jaw lesions depends on lesion size and location. While some smaller benign jaw lesions do not require therapy, knowledge of their imaging features is important, especially in order to differentiate them from malignant masses. Tori (singular: torus) are benign, non-odontogenic lesions of the mandible or the hard palate which consist mainly of compact bone (<xref rid="bibr1-2047981614522790" ref-type="bibr">1</xref>) and are usually detected incidentally.</p></sec><sec id="sec2-2047981614522790"><title>Case report</title><p>A 72-year-old male patient underwent magnetic resonance imaging (MRI) of the head and neck for follow-up, 1 year after resection of a metastasis located in the right soft palate. The patient had initially a Merkel cell carcinoma of the right elbow with ipsilateral axillary lymph node metastases. The metastasis of the right soft palate mentioned above occurred 1 year after initial diagnosis. MRI was performed on a 1.5 T system (Avanto; Siemens Medical Solutions, Erlangen, Germany). The MRI examination was performed according to the standard protocol for head and neck examination used at our institution, which includes T1-weighted (T1W) images in axial orientation, turbo inversion recovery magnitude (TIRM) images in axial and coronal orientation, T2-weighted (T2W) images in coronal orientation, and contrast-enhanced T1W images with fat saturation in axial and coronal orientation.</p><p>No metastasis recurrence or new metastases were detected on MRI. However, two relatively symmetrical, irregular protuberances were identified on the lingual aspect of the mandible. The protuberances did not show contrast enhancement and were isointense to compact bone, demonstrating very low signal intensity in all sequences (<xref ref-type="fig" rid="fig1-2047981614522790">Fig. 1</xref>). The lesions did not show signs of contrast media uptake. The maximum thickness of the lesions was 10 mm. Retrospectively, they were unchanged in comparison to a previous MR, which was performed for follow-up 6 months earlier. A CT scan performed 5 months after the MRI clearly identified the protuberances as solid bony structures (<xref ref-type="fig" rid="fig2-2047981614522790">Fig. 2</xref>), with densities as high as 1450 Hounsfield units (HU). They were also seen on a photograph made during a subsequent clinical examination (<xref ref-type="fig" rid="fig3-2047981614522790">Fig. 3</xref>). Based on these cumulative findings a diagnosis of mandibular tori was made.
<fig id="fig1-2047981614522790" position="float"><label>Fig. 1.</label><caption><p>MRI of the mandible. (a) Transverse T1W turbo spin echo (TSE) image; (b) TIRM TSE image; (c) T1W contrast-enhanced TSE image with fat saturation; (d) coronal T2W TSE image. In analogy to compact bone, the tori (white arrows) display very low signal intensity on all images and do not show contrast enhancement. Also note enhancing extraction pocket in the right mandible (red arrow).</p></caption><graphic xlink:href="10.1177_2047981614522790-fig1"></graphic></fig><fig id="fig2-2047981614522790" position="float"><label>Fig. 2.</label><caption><p>CT of the mandible. (a) Axial CT image; (b) coronal CT reconstruction. The tori (arrows) present as irregular, homogenous protuberances, isodense to compact bone.</p></caption><graphic xlink:href="10.1177_2047981614522790-fig2"></graphic></fig><fig id="fig3-2047981614522790" position="float"><label>Fig. 3.</label><caption><p>Photograph of the tori (arrows) acquired during clinical examination.</p></caption><graphic xlink:href="10.1177_2047981614522790-fig3"></graphic></fig></p><p>The patient reported no symptoms caused by the tori, which thus had no therapeutical consequence.</p></sec><sec sec-type="discussion" id="sec3-2047981614522790"><title>Discussion</title><p>While the etiology of tori is not well understood, some authors assume that there is a strong hereditary component (<xref rid="bibr2-2047981614522790" ref-type="bibr">2</xref>,<xref rid="bibr3-2047981614522790" ref-type="bibr">3</xref>). The reported prevalence of mandibular tori varies greatly between ethnic groups (<xref rid="bibr4-2047981614522790" ref-type="bibr">4</xref><xref rid="bibr5-2047981614522790" ref-type="bibr"></xref>–<xref rid="bibr6-2047981614522790" ref-type="bibr">6</xref>). Tori are found almost exclusively in adults. In more than 90% of cases, mandibular tori are bilateral (<xref rid="bibr4-2047981614522790" ref-type="bibr">4</xref>). Although tori may grow slowly, they are usually asymptomatic, except for some edentulous patients, in whom tori may hinder the fit of dental prostheses.</p><p>Most tori do not require therapy. Large tori may be removed, especially if they are an obstacle for prosthetic treatment (<xref rid="bibr1-2047981614522790" ref-type="bibr">1</xref>).</p><p>Tori are often incidentally identified on computed tomography (CT) scans. On CT, mandibular tori present as bony protuberances, isodense to compact bone and typically located on the lingual aspect of the mandible. Choi et al. reported a thickness range of 4.3–11.3 mm for mandibular tori on CT (<xref rid="bibr7-2047981614522790" ref-type="bibr">7</xref>). To our knowledge, the MRI characteristics of tori have not been described previously. As described above, the tori proved to have very low signal intensity on all MR sequences, as they consist of compact bone. It may be assumed that smaller tori are difficult to identify on MR because of their low signal. Furthermore, the detection of tori on MR may be problematic due to metal artifacts, which were nearly absent in the patient described in this case report. In our opinion, lesions which are isointense to compact bone on MRI and are located on the medial aspect of the mandible can be classified as tori without additional CT scans.</p><p>Most benign (e.g. neurofibroma, ameloblastoma) and malignant (e.g. lymphoma, squamous cell carcinoma, multiple myeloma) masses of the mandible are easy to distinguish from mandibular tori on CT or MRI because of bone destruction and lack of osteoblastic component. Chondrosarcoma or osteosarcoma of the mandible may have an osteoblastic component, but they also typically feature partial bone destruction and are unilateral. An important differential diagnosis of mandibular tori are exostotic osteoma found in patients with Gardner’s syndrome (<xref rid="bibr8-2047981614522790" ref-type="bibr">8</xref>). However, in contrast to tori these osteoma are typically numerous and asymmetrical, and often located on the buccal aspect of the mandible. In addition, patients with Gardner’s syndrome often have tooth impaction and odontoma.</p><p>In conclusion, our case report summarizes imaging features of mandibular tori, with special emphasis on MRI. The characteristic MRI features of compact bone and the typical location of tori on the medial aspect of the mandible allows differentiation of mandibular tori from other jaw lesions.</p></sec></body><back><ref-list><title>References</title><ref id="bibr1-2047981614522790"><label>1</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Garcia-Garcia</surname><given-names>AS</given-names></name><name><surname>Martinez-Gonzalez</surname><given-names>JM</given-names></name><name><surname>Gomez-Font</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Current status of the torus palatinus and torus mandibularis</article-title>. <source>Med Oral Patol Oral Cir Bucal</source><year>2010</year>; <volume>15</volume>: <fpage>e353</fpage>–<lpage>e360</lpage>.<pub-id pub-id-type="pmid">19767716</pub-id></mixed-citation></ref><ref id="bibr2-2047981614522790"><label>2</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Eggen</surname><given-names>S</given-names></name></person-group><article-title>Torus mandibularis: an estimation of the degree of genetic determination</article-title>. <source>Acta Odontol Scand</source><year>1989</year>; 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