A 43-year-old woman presented with left facial pain in different areas: auricular, preauricular, temporal, masterin, inferior border and angle of the jaw.
chronic joint disk and craniofacial muscle involvement was also found bilateral asymptomatic pterygoid with narrowing of the right muscle local state in bilateral pterygoid, left internal pterygoid, left superficial masseter muscle.
Otic symptoms: earache, tinnitus, vertigo and earache left taped without localized ear, nose or throat (ENT examination).
The patient in previous medical consultation was managed with anticonvulsant drug for possible painful origin in trigeminal neuralgia without resolution of the symptomatic picture.
I report the ineffectiveness of the AINES for their pain.
The patient complains of intense local pain in the left facial areas mentioned above.
The patient was anesthetized with xylocaine 2% in the palatal area corresponding to the hamular process, reporting the elimination of immediate pain.
The next scheduled appointment was 1 ml synthetic corticosteroid (Betamethasone - 4 mg suspension) prior to local anesthesia.
Subsequently (1 month later) and after resolution of hamular bursitis, the patient was managed with intraoral device for suppression of muscle activity (14) as treatment of TMD and otic symptoms that did not resolve.
It has been controlled for 2 years without recurrence of the original symptoms.
The referred otic symptoms are not mentioned in this case due to the fact that painful pathways corresponding to V2 or the maxillary trigeminal branch are involved.
However, the pain produced in the bursa of the hamular apophysis should be related to the muscular agonist activity of the mastication since the tensor muscles palatal velum and during the mastication are very active.
This muscle scenario should generate in the presence of pain increased activity of protective co-contraction and skeletal muscle presentation.
This leads us to ask ourselves why if the focus of pain in the palate is eliminated, symptoms or symptoms do not exist.
A reasonable explanation would be within the context of muscle-emotional hyperfunction with a biopsychosocial origin.
