PTERYGOID HAMULUS SYNDROME- A CASE REPORT
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Transcript of PTERYGOID HAMULUS SYNDROME- A CASE REPORT
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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
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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.
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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
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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.
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SHARP BONY PROJECTIONS BILATERALLY
INTRAORAL
EXAMINATION
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PROVISIONAL DIAGNOSIS
■ Elongated pterygoid process causing bursitis with referred pain on left side of
face.
DIFFERENTIAL DIAGNOSIS
Exostosis
Glossopharyngeal neuralgia
MPDS
Elongated styloid process
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RADIOGRAPHIC INVESTIGATION
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• Missing third molar
• Normal morphology of teeth and alveolus
• PROMINENT PTERYGOID PROCESS
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CBCT IMAGES OF CASE PATIENT NORMAL
PATIENT
CORONAL SECTIONS
AXIAL SECTIONS
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Diagnosis
Pterygoid Hamulus Syndrome
Treatment
Surgical resection of the elongated part of the bone
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SURGERY DONE BY:-
Dr. PRAJWALIT KENDE
Dr. JAYANT LANDGE
Dept of Oral Surgery, GDC-H Mumbai
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DISCUSSION
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Pterygoid plates Anatomy
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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.
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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
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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
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■ 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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