A Rare Cause of Pain in the Oral Cavity: Osteomyelitis of Tori

Abstract

A 63-year-old man presented with a 1-month history of worsening mouth pain, particularly under the tongue bilaterally, with left more than right. A physical examination revealed multiple dental caries and bilateral mandibular tori, with the left mandibular torus being exquisitely tender to palpation. Lab tests showed increased inflammatory markers in the absence of leukocytosis. A maxillofacial computed tomography scan revealed findings concerning for chronic osteomyelitis with osteolysis of the left mandibular torus. The patient was started on intravenous antibiotics and transferred to another institution for further management through their oral and maxillofacial surgery service. The surgical pathology after torectomy confirmed the diagnosis of acute osteomyelitis with osteonecrosis. Although rare, this case underscores the importance of familiarity with osteomyelitis in tori of the oral cavity, also highlighting the imaging and clinical correlation. Further research is necessary to understand the risk factors and optimal management strategies for similar cases.

Keywords: dental caries; exostoses; mandibular tori; oral diseases; oral tori; osteomyelitis; osteonecrosis; torectomy.

Figure 1. CT images showing bilateral mandibular tori with the left torus showing osteolytic changes

A) axial soft tissue window view B) axial bone window view C) coronal bone window view In Figures 1A-1C, the arrows highlight the torus mandibularis with the region of osteonecrosis/osteolysis. No direct communication with periodontal/periapical lucency or a radicular cyst related to any of the adjacent teeth was identified. Mild surrounding fat stranding was present without overt swelling, fluid collection, or disruption of the fat planes. Mild reactive lymphadenopathy in the left submandibular region was noted.