Recognition and Awareness

The Pterygoid Hamulus

The pterygoid hamulus is not a dinosaur.


Steve Erquiaga

“I have alternating symptoms every other day.
One day, there is a very sharp, icepick pain on the left side
with the sensation of a burning fluid ‘leaking’ and draining.
It feels as there is a splinter in my throat.
A vapor/fume burns this area of my mouth along with the splinter sensation.
The smell can be sickening; the taste obnoxious.
The next day, my throat feels swollen on the left side with fluid buildup.
Rhythmic breathing stimulates the fluid and ‘leaking’. 
A very disconcerting  vibration will 
up the back side of my head behind my left ear

The oral surgeon had recommended surgical removal (resection) of the pterygoid hamular process, reasoning that this could be the source of the ‘sharp’ sensation of pain that haunted my days and nights. The pterygoid process is attached to the very same bone – the medial pterygoid plate – that was thought to be fractured the day of the orthodontic equilibration procedure that initiated the bizarre shifting of the hamular process.

This small bone in the back of the palate had been protruding into the roof of the palate for two years, having shifted within 30 minutes of an orthodontic procedure while treating TMJ pain and occlusal realignment. The jaw joint and bite (occlusion) were manipulated by pivots bonded to teeth rather than using a dental splint that crossed the midline of the palate.

This surgery had been previously postponed due to my ‘anesthetic awareness’ experience that had transpired in the dental office with a diagnostic injection in the throat.  The cranial osteopathic treatment helped my autonomic nervous system to stabilize, deeply relaxing me during treatment; furthermore, I was able to consult with a psychologist specializing in EMDR.  Tapping with the psychologist and palpating with the osteopath… and in six weeks I boarded a flight back to Chicago to meet my friend from Tennessee who was going to be with me. Oral surgery would take place in a hospital, not the surgeon’s office. Anesthesia would be delivered through the nose, not the throat.

My friend was very knowledgeable about anesthesia. Her husband had died from an anesthetic reaction during a shoulder surgery.  Unbeknownst to them, he carried a genetic marker. Thus, she accompanied me to the consultation with the anesthesiologist before surgery armed with questions.  I felt I was in capable hands with her beside me.  Once back in my room, my friend, standing at the end of my bed, promptly passed out. I was able to get a nurse immediately. She recovered quickly. 

The compassion and gentleness of this surgeon were exceptional.  I brought a CD to play before, during and after the surgical procedure.  He was holding my hand as I drifted off and he was holding my hand when I opened my eyes.  My first awareness was of sound – hearing the selection that is the background for this page from The Impressionists with his voice softly saying, “Loved the music you brought us.”  All was calm; and he gently took my hand as I opened my eyes.

He informed me that the hamular process was ‘mush’. Typically, he would have to snap this little bone with his finger; instead, when he touched it, the bone disintegrated. 

And the missing puzzle-piece of my ‘movable palate’ surfaced. 
The traumatic bruising from intubation coupled with hypercoagulation issues
compromised microcirculation to the bone.

After twenty-five years, the bone had deteriorated and was labeled ‘necrotic’ (dead).
The orthodontic procedures had created too much stress and movement
for the palate to withstand; hence, the shift of the hamular process.

Was this the confounding issue with all the TMD splints?

The ‘Wait and See’ game began.

Would this surgical procedure alleviate
 the ice pick sensation and leaking manifestation?

The cat-bite incident with my hand was foremost in my mind when I learned there was impaired blood flow to the bone.

Having watched the radical reduction in the swelling of my ‘ballooned’ hand when the osteopath had treated 
 my arm and hand provided welcome reassurance that my body’s impaired microcirculation had assistance!

  “What in the world did you do?” I had exclaimed, after he finished his treatment.

All I did was increase blood circulation in your arm and hand,” 
was his straightforward reply, as if this was routine for him.

Increased circulation of fluids is an inherent ingredient
of osteopathic cranial treatment.

Miss Claire Remembers


Winter 1998


During my “Wait and See’ time, several months after the hamular resection in my palate, 
 an unusual happening provided more information
 …most definitely different from the oral surgeon’s pathology report! 

There was no where for me to catalog this experience.
This memory, written twenty-five years ago, will always remain inexplicable and mystifying.