In Part II, the symptoms and the process of diagnosis of bursitis of the hamular process is presented. Additionally, recommended treatment options will be. tini muscle was demonstrated and described histologically. ln Part Il, the symptoms and the process of diagnosis of bursitis of the hamular process is presentee!. Pain originating from the throat may emanate from many different structures. The stylohyoid and stylomandibular ligaments are known as.

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Pain on the soft palate and pharynx can originate in several associated structures. Therefore, gamular of patients who complain of discomfort in these areas may be difficult and complicated. Pterygoid hamulus bursitis is a rare disease showing various symptoms in the palatal and pharyngeal regions. As such, it can be one of the reported causes of pain in these areas. Treatment of hamular bursitis is either conservative or surgical. If the etiologic factor of bursitis is osteophytic formation on the hamulus or hypertrophy of the bursa, resection of the hamulus is usually the preferred surgical treatment.

Burrsitis report on a case of bursitis that was managed successfully by surgical treatment and a review of the literature. Although comprehension of various pain syndromes and diagnostic procedures has been advanced, the diagnosis of patients who complain of discomfort in the palatal and pharyngeal regions may be difficult and complicated. The basic difficulty in diagnosis arises because neurologic, myogenic, and psychogenic pain states in the facial region have considerable overlap in terms of the manifestation of their symptoms.

It has been reported that pain in the palate and pharynx can be caused by elongated styloid processes 1glossopharyngeal neuralgia 2salivary gland tumors 3myofascial pain dysfunction syndrome 4temporomandibular disorders, otitis media 5and impacted third molars.

Pterygoid hamulus bursitis can be another cause of pain in the soft palate and pharynx areas. Shankland 6 proved in the histological presence of the hamular process bursae. The primary function of the bursae is hamlar diminish the friction over the hamular process by the tendon of tensor veli palatini muscle and to make normal movement painless 7. When bursitis occurs, however, movement relying on the inflamed bursae becomes painful, aggravating its inflammation and perpetuating the problem.

There are several symptoms of pterygoid hamulus bursitis as described by Shankland 8: Sometimes, the patient has a clinical presentation similar to glossopharyngeal neuralgia, which makes swallowing solid food impossible 9.

To make an accurate diagnosis and distinguish a disease appropriately from these symptoms, a clinician needs to comprehend an associated disease thoroughly including pterygoid hamulus bursitis.

Nonetheless, this is a rare disease, and only several cases have been reported. The purpose of this article is to present a case of bursitis that was managed successfully through surgical treatment and discuss the pain associated with pterygoid hamulus bursitis with literature review. A hamuoar woman who had experienced painful sensation in the oral cavity, pharynx, and ear came haular Boramae Medical Center in June Other symptoms included difficulty swallowing and burning sensation of the oral cavity.

The pain was described as a pricking pain in the soft palate, causing the whole mouth and throat to be susceptible to the stimulus. The pain also radiated to the left ears. There was no history of trauma or injury. She had been undergoing treatment that involved administering antibiotics and nonsteroidal anti-inflammatory drugs for otic pain with stuffiness at several otorhinolaryngology clinics.

When she stopped taking the drugs, however, the pain recurred. Inthe patient noticed swelling and painful sensation in the region of the left palate. Her doctor injected steroid in the region correspondent with the hamulus. After steroid injection, she suffered no symptoms for 1 year. In Junehowever, the pain recurred again, so she was referred to our department.


The clinical oral examination revealed a palpable mass of the left soft palate, just medial and posterior to the maxillary tuberosity. The overlying palatal mucosa was normal.

This mass appeared to be pterygoid hamulus. According to the patient, the burning sensation had been present for 10 years, worsening when she touched the area with her tongue or finger.

In orthopantomography, no abnormality that induced the pain of the palate was evident. Computed tomography scans showing medially protruded pterygoid hamulus arrow. Hsmular Augustthe left pterygoid hamulus was resected under general anesthesia.

Following the incision of the overlying mucosa, surgical exposure of the pterygoid hamulus was performed using dissecting scissors. The pterygoid hamulus was removed from its base by bone rongeur. During the post-operative period 8 monthsthe patient suffered no palatal symptoms. Intraoperative photograph showing the pterygoid hamulus. Intraoperative photograph showing the tendon of levator veli palaini muscle after hamulotomy.

Pterygoid hamulus bursitis as a cause of craniofacial pain: a case report

Postoperative computed tomography scans showing removed left petrygoid hamulus arrow. Because pain in the soft palate or in the pharyngeal region may be due to various causes, it can present a diagnostic challenge to the clinician. Although bursitis of the pterygoid hamulus is an uncommon disease, consideration of the pterygoid hamulus as a pain-inducing factor should be included in the differential diagnosis. The information gleaned from the patient’s history and clinical findings may assist the clinician in reaching a more complete diagnosis.

This is especially important when the clinical examination of patients reveals no hamupar findings. In this case, since the major site of the pain starting from the soft palate was in the ear, she has been merely prescribed antibiotics and nonsteroidal anti-inflammatory drugs in the otolaryngology. She suffered a relapse of the symptoms after stopping the intake of drugs, however.

It means that such condition has no potential to be neuropathic disease but is just an inflammatory disease. The absence of tenderness over the muscles of mastication and the unusual initiation and distribution of pain in this patient made the diagnosis of myofascial pain dysfunction questionable.

Dupont hamulaf Brown 11 reported a case of tenderness to palpation in bursigis hamulus region, which was eliminated after anesthetic infiltration of the area. Shankland 12 also claimed that the use of anesthetic infiltration in the hamular area vursitis be beneficial in confirming the diagnosis of pterygoid hamular bursitis.

As far as treatment is concerned, there is no generally accepted protocol. Treatment of the pterygoid hamulus syndrome is either conservative or surgical. For palliative treatment, the local trauma origin must be hxmular, and a bursitiz diet is suggested. Injection of synthetic cortisone into the hamulus region can be another choice of conservative treatment. In case conservative treatment is unsuccessful, or if the etiologic factor of the bursitis is an elongation of the hamulus, surgical management would be considered.

Hertz 16Kronman et al. Shankland 8 discussed three cases of the hamular bursitis treated with injection hamula synthetic cortisone.

Among the three cases, one patient showed only a few days of relief. Surgical treatment was done, enabling the patient to be pain-free for 28 months. They commonly found a sharp prominence considered to be an elongated hamulus process associated with bamular stimulation; the symptom of patients disappeared completely after the operation.

The pterygoid hamulus or bursa is removed, but the tendon of the tensor veli palatini is left intact if at all possible. It is best to keep the function of the tensor veli palatine muscle intact, because there is a report that pterygoid hamulotomy proved to be effective procedures for the creation of experimental serous buraitis media in the cat Nonetheless, Noone et al.


In the presented case, the hamular area of the patient was injected with steroid, enabling the burwitis of the symptoms. Note, however, that the effect of steroid injection lasted for only 1 year, and the pain in the palate and ear returned. Thus, hamulotomy was performed. The post-operative course was uncomplicated, and the patient became completely pain-free without symptoms of otitis media. Even though there bursitia been many attempts to explain the mechanism of pain generated from the hamular area, the precise etiology bursitls not known.

According to Kronman et al. In addition, the osteophyte’s extension into the palatal musculature caused trauma because of the spicule’s penetration of palatal soft tissues. These events may stimulate the branches of the major and minor palatini nerve, glossopharyngeal nerve, and facial nerve, which may result in painful sensation.

Pterygoid hamulus bursitis as a cause of craniofacial pain: a case report

Under normal conditions, the normal function of the eustachian tube is to balance the pressure of the middle ear with that of the environment. The tensor veli palatini muscle dilates the eustachian tube and communicates with the nasopharynx 22 In this regard, the tensor tympani and tensor veli palatini muscles act simultaneously and synergistically, being able to increase intratympanic pressure temporarily. Consequently, tensor veli palatini dysfunction in hamular bursitis can modify the intratympanic environment and show various symptoms in the ear.

As a result, extra-activity in the middle ear can produce consequences such as vertigo, tinnitus, otalgia, hypoacusis, and fullness. In summary, a rare case of pterygoid hamulus bursitis was reported in this bursitks. The bursa of levator veli palatine muscle is present in the hamular region and can be a chronic inflammatory condition by burzitis.

The palatal and pharyngeal areas deserve special clinical attention especially in the differential diagnosis of a wide variety of oral and pharyngeal ahmular. Because the modality of treatment for bursitis is radically different from that for the other pain states in this region, the clinician should consider a probable diagnosis of bursitis.

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Abstract Pain on the soft palate and pharynx can originate in several associated structures. Bursitis, Facial pain, Palatal muscles, Palate, Pharynx.

Introduction Although comprehension of various pain syndromes and diagnostic procedures has been advanced, the diagnosis of patients who complain of discomfort in the palatal and pharyngeal regions may be difficult and complicated.

Case Report A year-old woman who had experienced painful sensation in the oral cavity, pharynx, and ear came to Boramae Medical Center in June Open in a separate window. Arrow indicates area of tenderness on palpation.

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