I have a (fairly common and essentially harmless, I understand)
condition of the inner surfaces of
my lower jaw, just below my front teeth, known as exostosis - several
small outgrowths of bone. Had it checked by my doctor, he agreed that
these lumps were most likely exostoses rather than anything more
sinister. He agreed I was probably taking the right course of action
by arranging an appointment with the dentist, to have them biopsied as
a precaution & possibly removed.

Here's a picture (yuk..warning to the squeamish!) I found from a quick
search to give an idea. This image, although not of my good self,
shows pretty similar-sized lumps, maybe a little larger, to my own:
 
http://www.usc.edu/hsc/dental/PTHL501/BT/d_bt_6.html

I'd like some links to information detailing what forms of surgery are
available for removal of these. From a very brief search I've heard of
the use of a bone burr, also the use of a chisel. Are there any other
options; what are the relative merits? Can removal be done under local
anaesthetic? Can all 4 of my 'lumps' be removed at one sitting? Would
it in fact be the best course of action to just leave well alone?
These things don't hurt but they do feel rather odd.

Not that I distrust my dentist; I'd just like to be informed before
visiting the surgery & be able to make an intelligent choice regarding
whatever options might be put forward.

---

Clarification of Question by gan-ga on 21 Jan 2003 20:01 PST

0400 GMT
Note to the researcher who is working on my question - thanks for your
attention to same - I'll be off to bed in 15 minutes or so, just in
case you need to make any clarification requests.

Greetings gan-

After an extensive search, I found very little information directly
discussing buccal exotoses removal procedures either on the web, in
Internet groups or in a search of periodicals.

Here is what I have gathered. Buccal exotoses and other such benign
tumors are often left untreated if they are not causing discomfort or
some practical problem.

Merck Manual
Noncancerous Bone Tumors
Osteochondromas (osteocartilaginous exostoses), the most common type
of noncancerous bone tumors, usually occur in people aged 10 to 20
years. These tumors are growths on the surface of a bone that protrude
as hard lumps. A person may have one or several tumors. The tendency
to develop several tumors may run in families. At some point in their
lives, about 10 percent of the people who have more than one
osteochondroma develop a cancerous bone tumor called a chondrosarcoma;
however, people who have only one osteochondroma are unlikely to
develop a chondrosarcoma.
Benign chondromas, which usually occur in people aged 10 to 30 years,
develop in the central part of a bone. These tumors often are
discovered when x-rays are taken for other reasons and often can be
diagnosed by their appearance on the x-ray. Some chondromas cause
pain. If a chondroma doesn't cause pain, it doesn't have to be removed
or treated. However, follow-up x-rays may be taken to monitor its
size. If the tumor can't be diagnosed with certainty on x-rays or if
it causes pain, a biopsy may be needed to determine whether it's
noncancerous or cancerous.
http://www.merckhomeedition.com/servlets/com.merck.servlets.

Treatment & Prognosis: Neither the torus nor the bony exostosis
requires treatment unless it becomes so large that it interferes with
function, interferes with denture placement, or suffers from recurring
traumatic surface ulceration (usually from sharp foods, such as potato
chips or fish bones). When treatment is elected, the lesions may be
chiseled off of the cortex or removed via bone bur cutting through the
base of the lesion.
http://www.maxillofacialcenter.com/BondBook/bone/exostosis.html#Quick

Various surgical instruments might be used to remove exotoses, the
choice it would seem is the surgeon's depending on individual
circumstances.
The tools used might include ronguers, a forceps-like bone cutting
tool, a drill with bur, or a bone chisel.

Here are some references to tool use and some descriptions:

 On the palate, cut down the midline and reflect back.      
 Take off palatal tori with a bur and mand tori with a chisel.
Instruments used to remove gross irregularities: rongeurs and bone
bur.
http://nnd40.med.navy.mil/Gen_Dent/Gen_Dent/FSBGD/Resident%20Study%20Guide%2000-01/Oral%20Surgery.doc

SURGICAL AIR DRILL
Many different makes and models of surgical air
drills are used in oral surgery. A common surgical air
drill used in the Navy is shown in figure 5-48. It is a
high-speed hand piece used in oral surgery procedures
to remove bone and section teeth. The drill enables the
dentist to accomplish these procedures quickly and
reduces the trauma to oral tissues. It operates by a hand
control lever while other makes and models operate by
a foot pedal.
http://216.239.53.100/search?q=cache:Bt39c5tep3MC:https://www.advancement.cnet.navy.mil/products/web-pdf/tramans/bookchunks/14275_ch5.pdf+surgery+bone+bur+chisel&hl=en&lr=lang_en&ie=UTF-8


Dental bur.
    (a) Identification. A dental bur is a rotary cutting device made
from carbon steel or tungsten carbide intended to cut hard structures
in
the mouth, such as teeth or bone.
http://www.siue.edu/DMSCH/SDMRAD/cfrpt21.872.html

Generally surgery involves the raising and protection of soft tissue
flaps and bone removal with either chisel or bur with water cooling
irrigation
http://www.sign.ac.uk/guidelines/fulltext/43/section5.html

Scalpels are not the only cutting
instrument used in surgery, particularly dental
surgery; for instance, curettes, chisel, rongeur forceps,
and bone files are also used in some cutting functions

Surgical Chisels
Surgical chisels may also be classified as cutting
instruments. Like surgical burs, chisels are used to
remove bone and to split teeth. 

Rongeur Forceps
Rongeur forceps  are used to trim
p r o j e c t i n g , u n e v e n , o r o v e r h a n g i n g b o n e
(alveolectomy), usually after multiple extractions and
before tissue suturing. It has a steel spring spreader,
which opens the beaks when pressure is released from
the handles.

 ronguers, a type of bone cutter
http://www.armatuk.com/englis/bone_rongeurs_1.htm

I could find no information on the type of anesthetic that might be
used other than one more extreme case study in which surgery was
performed under general ansesthesia.
"The patient was admitted to hospital for the procedure to be carried
out under general anaesthesia. Full thickness mucoperiosteal flaps
were raised in the maxilla to reveal the edentulous areas and on the
lingual aspect of the mandible bilaterally to expose the tori. The
tori were removed by making a groove adjacent to the lingual cortex
with a fissure bur followed by sectioning with an osteotome. The donor
sites were smoothed to remove any sharp prominences of bone followed
by copious irrigation with sterile saline."
http://www.nature.com/cgi-taf/DynaPage.taf?file=/bdj/journal/v190/n9/full/4801009a.html

 I'd conjecture that the type of anesthetic, the time required for the
procedure and whether or not all four of your exotoses might be
removed at once will depend on your particular circumstances and the
judgement of the oral surgeon.


Search strategies: buccal exostoses; buccal exostosis   
these two terms combined with: surgery, removal, oral surgery,
pathology, excision, treatment
exostoses; exostosis
Google web searches, group searches and image searches
Ebsco periodical searches on same terms


If you have questions about this response or require additional
information, please post a Request for Clarification before rating
this answer.

Nellie Bly
Google Answers Researcher

Thanks Nellie, I found your research readable & interesting.