Photo Rounds

Jaw pain

A middle-aged woman went to see her family physician (FP) because the left side of her jaw hurt. The FP noted that several of her bottom left molars were fully decayed. The patient acknowledged that was where the pain was localized. The FP also noted 2 firm, round, nontender masses under her tongue.

What's your diagnosis?


The FP diagnosed the masses as torus mandibularis caused by bony exostoses. These masses look like a torus palatinus and have the same pathophysiology. However, they are usually bilateral rather than at the midline.

Although this patient had multiple untreated dental problems, the tori were an incidental finding and the pain was due to her severe dental caries. There were no signs of a dental abscess, so the patient was referred to a dentist for dental extractions; no antibiotics were prescribed. The patient was also counseled about the importance of good oral hygiene. Surgical excision of the tori was not indicated.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: French L, Smith M. Torus palatinus. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:206-207.

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