Surgical Treatment of Osteonecrosis of a Torus Palatinus Secondary to Bisphosphonate Therapy: A Case Series and Literature Review

: Background Medication-related osteonecrosis of the jaw (MRONJ) is a known complication of long-term bisphosphonate therapy, most commonly affecting the mandible or maxilla. Involvement of a torus palatinus is rare with few cases documented in the literature. This case series highlights a rare presentation and its successful surgical management of total resection of the necrotic torus and reconstruction of the surgical defect using a vascularized local flap. Clinical Presentation and Management Two patients with a history of prolonged bisphosphonate use for osteoporosis presented with ulcerations and exposed bone along the hard palate. Clinical examination and imaging confirmed osteonecrosis of a torus palatinus with associated mucosal breakdown. Surgical intervention included total resection of necrotic mucosa and the necrotic torus palatinus, followed by reconstruction using a mucoperiosteal palatal island flap pedicled on the greater palatine vessels. Postoperative recovery was uncomplicated with successful flap integration and no evidence of recurrent disease. Conclusion The objective of this case series is to highlight the unique surgical and reconstructive approach employed in the management of medication-related osteonecrosis of the jaw occurring at the rare site of the torus palatinus. Compared to conservative measures or limited debridement, this series highlights the advantage of complete excision of necrotic torus palatinus in conjunction with vascularized tissue reconstruction. The use of a local vascularized flap, such as the palatal island flap, provides reliable soft tissue coverage and supports favorable postoperative healing over the site of necrosis.