Prominent mandibular tori and multifocal maxillary osseous outgrowths in post mortem forensic imaging: A case report

Prominent oral osseous outgrowths may be useful for forensic identification but may also create diagnostic uncertainty. This report documents marked mandibular tori associated with multifocal surface-based maxillary osseous outgrowths and evaluates their forensic significance. A 71-year-old man, found deceased in a parked vehicle in an advanced state of decomposition, underwent medicolegal autopsy and whole-body post mortem computed tomography (PMCT). Macroscopic findings, axial PMCT images, and three-dimensional volume-rendered reconstructions were assessed. Previous ante mortem imaging was reviewed separately as part of the identification process. PMCT demonstrated large bilateral multilobulated mandibular tori and multifocal vestibular maxillary osseous outgrowths. The maxillary lesions showed mature cortical architecture without destructive osteolysis, medullary invasion, aggressive periosteal reaction, or an associated soft-tissue mass. No traumatic injury suggesting third-party involvement was identified on PMCT or autopsy. The identity was established by ante mortem/post mortem cranial computed tomography comparison. The maxillary osseous outgrowths were visible on ante mortem imaging and contributed as ancillary concordant individualizing features, whereas the mandibular tori could not be assessed comparatively because the mandible was not included in the ante mortem acquisition. The mandibular tori were morphologically typical of prominent benign anatomical variants, whereas the maxillary outgrowths were radiologically most consistent with benign exostotic or hyperostotic remodeling but were not histopathologically confirmed. Their morphology may provide useful ancillary information for identification, provided that documented ante mortem correspondence is available. Such findings should not be attributed to malignancy, systemic disease, or cause of death without convergent clinical, radiologic, autopsy, or histopathological evidence.