Pterygoid Hamulus Bursitis: A Rare and Overlooked Cause of Orofacial Pain

Abstract

Pterygoid hamulus bursitis (PHB) is an infrequently reported condition that presents with chronic orofacial pain, often misdiagnosed as temporomandibular disorders (TMDs) or other common craniofacial pain syndromes. This condition arises from inflammation of the bursa surrounding the pterygoid hamulus (PH), a small hook-like bone structure of the sphenoid bone. Anatomical variations such as elongation of the PH or repetitive mechanical irritation are among the primary causes of this rare pathology. Clinically, PHB manifests as pain radiating to the soft palate, throat, or temporomandibular joint area, accompanied by symptoms such as dysphagia or otologic discomfort. This comprehensive review examines the current understanding of PHB, including its anatomy, pathophysiology, clinical presentation, diagnostic challenges, and management strategies, based on the available literature and clinical evidence. Early recognition and appropriate management, including surgical intervention when necessary, are essential to alleviate symptoms and prevent long-term complications.

Keywords

• Bursitis
• facial pain
• synovial bursa
• temporomandibular joint
• oral surgery

Kaynakça

1. Van Deun L, de Witte M, Goessens T, et al. Facial pain: a comprehensive review and proposal for a pragmatic diagnostic approach. Eur Neurol. 2020;83:5-16.
2. Giral CR, Diaz-Manchay R, Leon-Jimenez F. Fibromyalgia: the underdiagnosed disease of pain. Reumatologia. 2021;59:64.
3. Orhan K, Sakul BU, Oz U, Bilecenoglu B. Evaluation of the pterygoid hamulus morphology using cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112:e48-55.
4. Shetty SS, Shetty P, Shah PK, et al. Pterygoid hamular bursitis: a possible link to craniofacial pain. Case Rep Surg. 2018;2018:5108920.
5. Shankland WE 2nd. Pterygoid hamulus bursitis: one cause of craniofacial pain. J Prosthet Dent. 1996;75:205-10.
6. Barchetta N, Oliveira R, Silveira V, Faig-Leite H. Clinical and morphofunctional aspects of pterygoid hamulus: literature review. Braz Dent Sci. 2015;18:5.
7. Putz R, Kroyer A. Functional morphology of the pterygoid hamulus. Ann Anat. 1999;181:85-8.
8. Shankland WE 2nd. Bursitis of the hamular process. Part II: Diagnosis, treatment and report of three case studies. Cranio. 1996;14:306-11.

9. Ramirez LM, Ballesteros LE, Sandoval GP. Hamular Bursitis and its possible craniofacial referred symptomatology: two case reports. Med Oral Patol Oral Cir Bucal. 2006;11:E329-33.
10. 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. Int J Oral Maxillofac Surg. 1997;26:275-7.
11. Komarnitki I, Skadorwa T, Chloupek A. Radiomorphometric assessment of the pterygoid hamulus as a factor promoting the pterygoid hamulus bursitis. Folia Morphol (Warsz). 2020;79:134-40.
12. Krmpotić-Nemanić J, Vinter I, Marusić A. Relations of the pterygoid hamulus and hard palate in children and adults: anatomical implications for the function of the soft palate. Ann Anat. 2006;188:69-74.
13. Kende P, Aggarwal N, Meshram V, et al. The pterygoid hamulus syndrome - an important differential in orofacial pain. Contemp Clin Dent. 2019;10:571-6.
14. Firdouse A, Firdoose N, Ghousia S. An unusual clinical vignette of oro-pharyngeal discomfort: Pterygoid Hamulus syndrome. Med Pharm Rep. 2020;93:306-9.
15. Luis Baerga-Varela M, Raul A. Rosario-Concepión M. Knee Bursopaty. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th edition. Philadelphia: Elsevier; 2019;399-402.
16. Williams CH, Jamal Z, Sternard BT. Bursitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 24, 2023.
17. Elmonofy O, ELMinshawi A, Mubarak F. Pterygoid hamulus elongation syndrome. Int J Surg Case Rep. 2021;78:81-4.
18. Chatra PS. Bursae around the knee joints. Indian J Radiol Imaging. 2012;22:27-30.
19. Baker HP, Gutbrod J, Cahill M, Shi L. Optimal treatment of proximal humeral fractures in the elderly: risks and management challenges. Orthop Res Rev. 2023;15:129-37.
20. Salins PC, Bloxham GP. Bursitis: a factor in the differential diagnosis of orofacial neuralgias and myofascial pain dysfunction syndrome. Oral Surg Oral Med Oral Pathol. 1989;68:154-7.
21. Shah A, Guduba V, Tejaswini K, Kothari C. Elongated pterygoid hamulus: a case report. Indian J Otolaryngol Head Neck Surg. 2023;75:3830-3.
22. Prats-Sisquella B, Peeva NA, Jorba-Garcia A, et al. Hamular bursitis as a cause of orofacial pain. A case report. J Clin Exp Dent. 2023;15:e599-604.
23. Wooten JW, Tarsitano JJ, Reavis DK. The pterygoid hamulus: a possible source for swelling, erythema, and pain: report of three cases. J Am Dent Assoc. 1970;81:688-90.
24. Galvez P, Moreau N, Fenelon M, et al. Pterygoid hamulus syndrome: a case report. J Oral Med Oral Surg. 2020;26:42.
25. Cho JY, Cheon KY, Shin DW, et al. Pterygoid hamulus bursitis as a cause of craniofacial pain: a case report. J Korean Assoc Oral Maxillofac Surg. 2013;39:134-8.
26. Thukral H, Nagori SA, Rawat A, Jose A. Pterygoid hamulus bursitis: a rare intra-oral pain syndrome. J Craniofac Surg. 2019;30:e643-5.
27. Sattur AP, Burde KN, Goyal M, Naikmasur VG. Unusual cause of palatal pain. Oral Radiol. 2011;27:60-3.
28. Kronman JH, Padamsee M, Norris LH. Bursitis of the tensor veli palatini muscle with an osteophyte on the pterygoid hamulus. Oral Surg Oral Med Oral Pathol. 1991;71:420-2.
29. Sasaki T, Imai Y, Fujibayashi T. A case of elongated pterygoid hamulus syndrome. Oral Dis. 2001;7:131-3.
30. Maracineanu R, Motoc M, Talpos-Niculescu RM, et al. Medial deviation of the pterygoid hamulus as an uncommon cause of persistent oral and facial pain - a rare case report and literature review. Cranio. 2025;43:253-7.
31. Bandini M, Corre P, Huet P, Khonsari RH. A rare cause of oral pain: The pterygoid hamulus syndrome. Rev Stomatol Chir Maxillofac Chir Orale. 2015;116:380-3.
32. Charbeneau TD, Blanton PL. The pterygoid hamulus: a consideration in the diagnosis of posterior palatal lesions. Oral Surg Oral Med Oral Pathol. 1981;52:574-6.
33. Butts R, Dunning J, Pavkovich R, et al. Conservative management of temporomandibular dysfunction: a literature review with implications for clinical practice guidelines (Narrative review part 2). J Bodyw Mov Ther. 2017;21:541-8.
34. Fricton JR. Management of masticatory myofascial pain. Semin Orthod. 1995;1:229-43.