PTERYGOID HAMULUS SYNDROME- A CASE REPORT

pterygoid hamulus syndrome is a rare disorder of oral cavity involves elongation of pterygoid hamulus of medial pterygoid plate.

1. Pterygoid Hamulus Syndrome a case report Dr. Shuddhodhan Gaikwad PG 1 st year Dept.of OMDR Guided by:- Dr. H R Umarji Prof. & Head dept.of OMDR Dr. Sonali Kadam Associate Prof. OMDR

2. 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.

3. 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

4. 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.

5. SHARP BONY PROJECTIONS BILATERALLY INTRAORAL EXAMINATION

6. PROVISIONAL DIAGNOSIS Elongated pterygoid process causing bursitis with referred pain on left side of face. DIFFERENTIAL DIAGNOSIS Exostosis Glossopharyngeal neuralgia MPDS Elongated styloid process

7. Radiographic investigation

8. Missing third molar Normal morphology of teeth and alveolus PROMINENT PTERYGOID PROCESS

9. CBCT IMAGES OF CASE PATIENT NORMAL PATIENT CORONAL SECTIONS AXIAL SECTIONS

10. Diagnosis Pterygoid Hamulus Syndrome Treatment Surgical resection of the elongated part of the bone

11. SURGERY DONE BY:- Dr. PRAJWALIT KENDE Dr. JAYANT LANDGE Dept of Oral Surgery, GDC-H Mumbai

12. discussion

13. Pterygoid plates Anatomy

14. 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.

15. E ffects 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

16. 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. C onclusion

17. 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 12 th ediotion Gray’s anatomy 3 rd edition References