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