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

Pterygoid Hamulus: Morphological Analysis and Clinical Implications

INTRODUCTION

 The pterygoid hamulus (PH), as a small and curved projection of the sphenoid bone, occupies a unique position at the skull base. Given its functional relation with the surrounding anatomical structures, the study of this rather underrepresented structure in the literature assumes paramount importance.

MATERIALS AND METHODS

We examined a total of 87 pterygoid hamuli (50 right-sided and 37 left-sided) out of a sample of 114 dry skulls. We measured the length, width, and angle of each PH and the interpterygoid distance in skulls with both pterygoid hamuli intact, and we calculated the mean, maximum, and minimum values.

RESULTS

Our statistical analysis revealed the mean length (0.9 cm), width (0.3 cm), and angle (47.8°) of the PH, as well as the mean interpterygoid distance (3.31 cm). We recorded the longest-ever documented PH (1.64 cm). The obtained length values were higher than those provided by radiological studies. We also investigated possible associations between anatomy and pathological conditions related to the PH morphology, including pterygoid hamular elongation syndrome, hamular fracture, middle ear disorders, and obstructive sleep apnea syndrome.

CONCLUSION

Our study uses precise measurement techniques to detail the anatomy of the PH in dry skulls. This research can be a valuable resource for future studies, advancing our understanding of the PH's structure and its clinical significance.

Medial deviation of the pterygoid hamulus as an uncommon cause of persistent oral and facial pain - a rare case report and literature review

BACKGROUND

Pterygoid hamulus syndrome, a painful oral and facial syndrome, has been described in literature to be correlated with morphological changes in the length of the pterygoid hamulus of the sphenoid bone.

CLINICAL PRESENTATION

The current case report describes the treatment for severe, continuous pain in the posterior right palate. Despite numerous conservative treatments given to the patient, no improvement was seen. Cone beam computed tomography (CBCT) measurements revealed an elongation as well as a significant medial deviation of the lower extremity of the medial pterygoid plate. The surgical resection was performed under local anesthesia. The pain subsided two days after the surgery, and there were no relapses in the weeks that followed.

CONCLUSION

The medial deviation of the hamulus appeared to be important in the etiology of this painful syndrome. Additional research based on CBCT measurements will be required.

Pterygoid hamulus elongation syndrome

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Pterygoid hamulus elongation syndrome is an extremely rare condition, existed around in 1% of humanity.

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Pain in the soft palate and pharynx can originate from numerous related pathological or anatomical structures.

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The diagnosis of hamular elongation should be based on the detailed history, clinical examination, and correlation with radiographic imaging.

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Management of hamular elongation is preferably to be done with surgical resection, and the conservative solution should be used in limited circumstances.

Introduction

Pain in the soft palate and pharynx can originate from numerous related anatomical structures. Therefore, the diagnosis of patients who complain of pain in these areas is also difficult and challenging. One of the anatomic disorders that causes pain and discomfort in this region is pterygoid hamulus elongation syndrome.

Presentation of case

We report a rare case of pterygoid hamulus elongation with persistent sharp localized pain in the hamular region radiating to the temporal area for four years that was treated successfully by surgical resection of elongated hamulus.

Discussion

Pterygoid Hamulus elongation syndrome is a unique disease presenting many symptoms in the palatal and pharyngeal areas. May caused by injury, infection, or a pre-existing condition. The diagnosis of hamular elongation should be based on detailed history, clinical examination, and correlation with radiographic imaging.

Conclusion

Due to the rarity, PHE syndrome should be diagnosed accurately. Management of hamular elongation is either surgical or conservative but resection of the pterygoid hamulus is usually preferred.

Pterygoid hamulus syndrome: a case report

Introduction: Pterygoid hamulus syndrome (PHS) is a little-known differential diagnosis of orofacial pain. It is characterized by oropharyngeal pain, secondary to inflammatory bursitis of the tensor veli muscle of post-traumatic origin, frequently fostered by an associated hypertrophy of the hamular process. Observation: A 64-year-old female patient, type 2 diabetic, consulted for constant posterior palatal pain located near to 17, lasting for 10 years. The inspection did not reveal any mucosal lesions. Right hamulus palpation increased the pain and revealed hamulus hypertrophy. A diagnosis of PHS was evoked. Comment: A review of the literature is proposed. The treatment of PHS is initially conservative, but a surgical treatment can be proposed in case of morphological anomalies. Conclusion: PHS is a little-known syndrome whose diagnosis must be mentioned by the oral surgeon faced with chronic oropharyngeal pain. The diagnosis is clinical and radiological, the treatment is medical and/or surgical.

An unusual clinical vignette of oro-pharyngeal discomfort: Pterygoid Hamulus syndrome

Background

A straightforward clinical reasoning is always difficult in patients with persistent orofacial pain with vague symptoms. Craniofacial pain or Orofacial pain can have a mixture of causes ranging from neurogenic, myogenic, and psychogenic factors intertwined amidst the intricate anatomy with a high vascular network. This plethora of uncertainty blurs the judgment for such patients to whom we provide care. We hereby present a case of a 17 year old female with vague pain on talking, chewing and even swallowing when initially examined; this chronic orofacial pain often worsened her quality of life. The aim of this manuscript is to present a case of Pterygoid Hamulus syndrome that was misdiagnosed as glossopharyngeal and myofascial neuralgia.

Methods

The condition was managed by surgical excision of the elongated pterygoid hamulus, following a recurrence of her symptoms.

Results

The patient was relieved of pain only after the surgical excision of the elongated hamulus.

Conclusions

The surgery was decided upon only after conservative management had not provided much relief and the manuscript also discusses the ambiguous composite pain referral pattern in Pterygoid Hamulus syndrome.

The Pterygoid Hamulus Syndrome - An Important Differential in Orofacial Pain

The purpose of this review was to document cases of pterygoid hamulus (PH) syndrome and to describe the various etiology, differential diagnosis, and management strategies so far reported in literature. Here, we also present two case reports of PH syndrome. A comprehensive search in PubMed/Medline database was done using MeSH terms such as "Pterygoid Hamulus," "Pterygoid Hamulus Syndrome," and "Hamular Bursitis" using various Boolean operators such as "AND" and "OR". Till date, 31 cases of this entity including the present cases have been found. Conservative management was followed in the earlier reported cases; however, most cases were treated by surgical resection.

Functional morphometry of the pterygoid hamulus. A comparative study of modern and medieval populations

The pterygoid hamulus (PH) is located in the infratemporal fossa and is part of the pterygoid process of the sphenoid bone. Its location on the cranial base and the multitude of anatomical structures whose attachments lie on the surface of the pterygoid hamulus make it of high functional and topographic significance. Due to insufficient literature on the PH morphometry, we decided to study this issue using modern and archaeological material. In total, 99 observations were subjected to quantitative and qualitative analysis (50 - from modern times and 49 - from medieval times). On the basis of the statistical analysis, statistically significant differences in the length of PH were found with respect to age and sex. Statistically significant differences in the PH width were also noticed with respect to sex and the period of origin. The results obtained may help better understand the development mechanism of the pterygoid hamulus bursitis.

Pterygoid Hamular Bursitis: A Possible Link to Craniofacial Pain

A striking feature of the skull base is the pterygoid hamulus known for its bizarre morphology and biomechanical location. Pterygoid hamular bursitis is an inflammation of bursae located between the tendon, muscle, and bony prominences. The minimal objective finding in an apparently normal orofacial apparatus and dependence on the subjective symptoms experienced by the patient with widespread referral pattern often perplexes the clinician. Bursitis should be considered in the differential diagnosis of craniofacial neuralgia, temporomandibular joint dysfunction, and chronic craniofacial pain. Clinical signs and symptoms of this intriguing entity are diverse and multifaceted that can sometimes demand services of clinicians across various specialties considering the anatomic density of the region. Care must be taken to avoid delay, misdiagnosis, and overtreatment.