Hamulotomy in the treatment of a case of PHS refractory to medical treatment (case not presented). (A) Careful dissection of the right hamular region. (B) Removal of the tendon bursa of the tensor veli palatini muscle (being careful not to damage the muscle or twigs of the little palatine nerve). (C) Bone resection of the residual hamulus (until the whole palpable prominence disappears). It is worth noting the secretion of the ipsilateral accessory salivary glands (due to the stimulation of the nearby parasympathetic secretory nerve fibres during the surgical procedure).