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PTERYGOID HAMULUSSYNDROME
A CASE REPORT
Dr. Shuddhodhan Gaikwad
PG 1st year
Dept.of OMDR
Guided by:-
Dr. H R Umarji
Prof. & Head dept.of
OMDR
Dr. Sonali Kadam
Associate Prof.
OMDR
INTRODUCTION
■ Pain in orofacial region presents a medical problem when it progresses to
become chronic or occurs in an unusual form.
■ The basic difficulty in diagnosis arises because neurologic ,myogenic &
psychogenic pain states in the facial region have considerable overlap in the
manifestation of their symptoms.
Case report
■ 23 year /Male
■ Chief complaint - Pain on left side of face since 2 to 3 years and pain aggravates
on swallowing.
■ History of Presenting Illness – Pain in same region since three years, Patient was
previously treated for MPDS and was prescribed muscle relaxants and analgesics.
Patient got relief only till the effect of medicines lasted.
■ Past Medical History – Not significant
EXTRA ORAL
FINDINGS
■ Bilaterally symmetrical face
■ No swelling present
■ On palpation – generalized tenderness on left side of face on the cheek and mandibular
body region, but no obvious trigger point could be located.
SHARP BONY PROJECTIONS BILATERALLY
INTRAORAL
EXAMINATION
PROVISIONAL DIAGNOSIS
■ Elongated pterygoid process causing bursitis with referred pain on left side of
face.
DIFFERENTIAL DIAGNOSIS
Exostosis
Glossopharyngeal neuralgia
MPDS
Elongated styloid process
RADIOGRAPHIC INVESTIGATION
• Missing third molar
• Normal morphology of teeth and alveolus
• PROMINENT PTERYGOID PROCESS
CBCT IMAGES OF CASE PATIENT NORMAL
PATIENT
CORONAL SECTIONS
AXIAL SECTIONS
Diagnosis
Pterygoid Hamulus Syndrome
Treatment
Surgical resection of the elongated part of the bone
SURGERY DONE BY:-
Dr. PRAJWALIT KENDE
Dr. JAYANT LANDGE
Dept of Oral Surgery, GDC-H Mumbai
DISCUSSION
Pterygoid plates Anatomy
What is BURSITIS ??
■ Bursa is a latin word which means a purse ; it is a closed sac or envelop lined with synovial
membrane and containing synovial fluid . It acts as a cushion/ lubricant between bones,
tendons, Joints and muscles.
■ A bursa is a device for eliminating friction whenever a muscle or tendon is liable to rub on
another muscle , tendon or bone.
■ Inflammation of Bursa is called BURSITIS.
■ Minor infection or trauma may cause an increase in the quantity of the bursa fluid , leading
to enlargement of the bursa. This may result in pain and limitation of movements.
Effects of elongated pterygoid process
■ Pain and sensation of strangeness
■ Burning and swelling of the hard/soft palate
■ Elevated noise sensitivity
■ Dysphagia
■ Dysfunction of muscles
■ Headache and hearing disorders
■ Pain and clicking in temporomandibular joint
From the case presented , it can be learnt that when the correct diagnosis is not made
at an early stage , the patient may be the victim of mismanagement leading to a
psychological upset which clouds the initial complaints even more . This vicious circle
needs to be interrupted.
Conclusion
■ Salins PC, Bloxham GP. Bursitis: a factor in the differential diagnosis of orofacial
neuralgias and myofascial pain dysfunction syndrome. Oral surgery, oral medicine, oral
pathology. 1989 Aug 31;68(2):154-7.
■ Krmpotić-Nemanić J, Vinter I, Marušić A. Relations of the pterygoid hamulus and hard
palate in children and adults: anatomical implications for the function of the soft palate.
Annals of Anatomy-Anatomischer Anzeiger. 2006 Jan 3;188(1):69-74.
■ Eyrich GK, Locher MC, Warnke T, Sailer HF. The pterygoid hamulus as a pain-inducing
factor: A report of a case and a radiographic study. International journal of oral and
maxillofacial surgery. 1997 Aug 31;26(4):275-7.
■ Sattur AP, Burde KN, Goyal M, Naikmasur VG. Unusual cause of palatal pain. Oral
Radiology. 2011 Jun 1;27(1):60-3.
■ Burket’s oral medicine 12th ediotion
■ Gray’s anatomy 3rd edition
References
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