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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 28  |  Issue : 1  |  Page : 66-69

Analysis of morphological variation of condyle by cone-beam computed tomography: Report of two cases


Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication8-Sep-2016

Correspondence Address:
Hemavathy Bhaskar Yesupogu
Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai - 600 003, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.189991

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   Abstract 

Bifid mandibular condyle is a rare entity, in which the head of the condyle presents with double head usually separated by notching between the heads, thus it is also known as double-headed condyle. It is a frequent and purely incidental finding, mostly found in asymptomatic individuals during routine radiological investigation. It may occur as a developmental anomaly or due to trauma. Here, we report two unique cases of unilateral bifid condyles, which was an incidental finding during diagnostic imaging procedure.

Keywords: Developmental anomaly, double-headed condyle, radiological investigation


How to cite this article:
Kartikeyan B, Sadaksharam J, Yesupogu HB. Analysis of morphological variation of condyle by cone-beam computed tomography: Report of two cases. J Indian Acad Oral Med Radiol 2016;28:66-9

How to cite this URL:
Kartikeyan B, Sadaksharam J, Yesupogu HB. Analysis of morphological variation of condyle by cone-beam computed tomography: Report of two cases. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2022 Jul 3];28:66-9. Available from: https://www.jiaomr.in/text.asp?2016/28/1/66/189991


   Introduction Top


Bilobed mandibular condyle (BMC) is a rare anomaly. Hrdlicka was the first to describe this condition in 1941. However, Schier (1948) was the first to report this condition in a living individual.[1] The two articulating surfaces of the bifid condyle are divided by a groove which can be oriented either mediolaterally or anteroposteriorly.[2] Causes of BMC include developmental anomalies, teratogenic embryopathy, condylar fracture and perinatal trauma, and surgical condylectomy.[3] The anomaly is usually unilateral but may also occur bilaterally. It has no marked predilection for any side. It is usually asymptomatic.[4] BMC is usually an incidental finding on routine radiographic examination.[5]


   Case Reports Top


Case 1

A 45-year-old male reported with the complaint of swelling over the right side of cheek for the past 3 days and restricted mouth opening. His past medical and surgical history was noncontributory and no history of trauma was present. On clinical examination, no tenderness over temporomandibular joint (TMJ) region was present, so an orthopantomograph (OPG) was taken for further evaluation. OPG revealed evidence of morphological variation of the left condylar head [Figure 1].
Figure 1: Orthopantomograph shows bifid condyle on left side

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Cone-beam computed tomography (CBCT) was taken to analyze the variation. Axial section of left condyle showed notching of left condyle dividing the condylar head into two parts [Figure 2]a. The mediolateral dimension of mesial lobe measured 10.6 mm with an anteroposterior dimension of 8.3 mm. The mediolateral width of distal lobe measured 6.2 mm with an anteroposterior width of 7.6 mm. Coronal section of left condyle revealed central notching of left condyle with presentation of two heads and neck width measuring 5.5 mm [Figure 2]b. Sagittal section revealed notching in the left condylar head with anteroposterior width of mesial lobe measuring 9.2 mm and distal lobe measuring 7.9 mm; thus, the combined width of both lobes was 19.7 mm [Figure 2]c. Three-dimensional (3D) reconstructed image revealed bifid condyle [Figure 3].
Figure 2: (a) Axial section revealing notching of left condyle with the presentation of two condylar head. (b) Coronal section of left condyle revealing central notching with presentation of two condylar heads. (c) Sagittal section revealing notching on left condylar head

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Figure 3: Three-dimensional reconstructed image of bifid condyle on left side

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Case 2

A 50-year-old female reported with a chief complaint of pain in front of the left ear for the past 2 months. Her past medical and surgical history was noncontributory and no history of trauma was present. On clinical examination, tenderness of left TMJ was present and deviation of mandible to the left side was evident, so an OPG was taken for further evaluation. OPG revealed evidence of anatomic variation of right condyle [Figure 4]. CBCT was taken to analyze the variation of right condyle. Axial section of right condyle revealed notching of the right condyle with the presentation of two condylar heads [Figure 5]a. The mediolateral width measured 5.2 mm and anteroposterior width was found to be 6.4 mm on the mesial lobe of the bifid condyle. The mediolateral width of the distal lobe was 7 mm and anteroposterior width of the distal lobe was 6.4 mm. Coronal section showed a central notch in the head of condyle on right side with the presentation of two condylar heads [Figure 5]b. The anteroposterior width of mesial lobe measured 6.7 mm and the distal lobe measured 6.3 mm in width. Sagittal section showed anatomical variation on right side of condyle [Figure 5]c. The neck length measured 10.9 mm and intra-articular space was 2.8 mm. 3D reconstructed image showed evidence of bifid condyle on right side of TMJ [Figure 6].
Figure 4: Orthopantomograph shows anatomic variation on right side of condyle

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Figure 5: (a) Axial section of right condyle revealing notching of the right condyle with the presentation of two condylar head. (b) Coronal section showing central notch in the head of condyle on right side with the presentation of two condylar head. (c) Sagittal section shows anatomical variation on right side of condyle

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Figure 6: Three-dimensional reconstructed image of bifid condyle on right side

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   Discussion Top


The bifid mandibular condyle is a rare anomaly with unknown cause. Evidence suggests that the etiology of this malformation can be either traumatic or developmental.[6] BMC occurs in age group ranging from 3 to 67 years (with a mean age of 35 years) and the male:female ratio was approximately 1.5:1. Preponderance of bifid condyle was found more on the left side than the right side.[7] In this study, case 1 presents with bifid condyle on right side rather than left side which was not the most common site as per literature. The morphology of the bifidity ranges from grooving to discrete condylar heads, with the orientation running sagitally or coronally. The prevalence of BMC ranges from 0.018% to 1.82%.[8] The unilateral BMCs were 3 times more prevalent than bilateral. However, in our case, the etiology was not clear as the patients had no history of trauma. Hrdlicka postulated that blood supply was obstructed to the condyle during development causing division of the condyle.[9] Blackwood examined the developing condylar cartilage of the human fetus and found that it was partitioned by vascularized fibrous septa during the early phase. Persistence of these septa or rupture of blood vessels in the septa was believed to be a cause for the development of bifid condyle.[2] Symptoms of bifid condyles vary from case to case but, in most instances, symptoms are absent. The most common and predominant symptoms reported are TMJ sounds, pain, restriction of mandibular movement, trismus, swelling, ankylosis, and facial asymmetries.[10] In this paper, both patients were asymptomatic. Zohar and Laurian described unusual findings in a female patient with bifid mandibular condylar head associated with polythelia, bilateral postminimum digit and clinodactyly. There are possible chances for occurrence of these conditions.[11] In this paper, case 2 did not show any above mentioned findings.

Dennison suggested that the term bifid condyle should be reserved only for those cases where the bifidity appears both in the anterior and in the posterior part of the sagittal plane, and the rest of the cases should be classified as a cleft, notch or gap, thus considering them to be false bifid condyles.[12] BMC has been generally considered in cases in which a condyle arises to be duplicated anteroposteriorly or mediolaterally.[13] In this paper, no condyle showed anteroposterior bifidity. It is hypothesized that anteroposterior bifidity presented concomitant to mediolateral orientation, but this may not be true for all cases. A BMC could be oriented in an oblique position that is not anteroposterior or mediolateral. The diagnosis of the bifid condyle is based on its radiographic appearance, which is almost always diagnosed by chance. The bifid condyle may be discovered on routine dental radiographic examination or during the investigation of another problem.[14] Hence, in the present case, it was an incidental radiographic finding while investigating another problem. The treatment of the symptomatic bifid condyle is usually conservative and similar to the treatment for the closely associated TMJ pain dysfunction syndrome, namely analgesics and anti-inflammatory agents, muscle relaxants, physiotherapy and splint.


   Conclusion Top


Bifid mandibular condyles are associated with or without symptoms. The diagnosis of a bilobed condyle usually relies on radiological findings rather than clinical findings. Hence, the diagnosis of this incidentally found abnormality is important for dentists. In addition, the dental professionals should have appropriate knowledge about this anatomical abnormality as well as its implications for a potential diagnosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Tejasvi A, Chatra L, Shenai KP. Bilateral bifid mandibular condyle. J Clin Diagn Res 2011;5:390-2.  Back to cited text no. 1
    
2.
Blackwood HJ. The double-headed mandibular condyle. Am J Phys Anthropol 1957;15:1-8.  Back to cited text no. 2
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3.
Fields RT, Frederiksen NL. Facial trauma confusing the diagnosis of a bifid condyle. Dentomaxillofac Radiol 1993;22:216-7.  Back to cited text no. 3
[PUBMED]    
4.
Jordana X, García C, Palacios M, Chimenos E, Malgosa A. Bifid mandibular condyle: Archaeological case report of a rare anomaly. Dentomaxillofac Radiol 2004;33:278-81.  Back to cited text no. 4
    
5.
Cowan DF, Ferguson MM. Bifid mandibular condyle. Dentomaxillofac Radiol 1997;26:70-3.  Back to cited text no. 5
[PUBMED]    
6.
Alpaslan S, Ozbek M, Hersek N, Kanli A, Avcu N, Firat M. Bilateral bifid mandibular condyle. Dentomaxillofac Radiol 2004;33:274-7.  Back to cited text no. 6
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7.
Antoniades K, Karakasis D, Elephtheriades J. Bifid mandibular condyle resulting from a sagittal fracture of the condylar head. Br J Oral Maxillofac Surg 1993;31:124-6.  Back to cited text no. 7
[PUBMED]    
8.
Gunduz K, Buyuk C, Egrıoglu E. Evaluation of the prevalence of bifid mandibular condyle detected on cone beam computed tomography images in a Turkish Population. Int J Morphol 2015;33:43-7.  Back to cited text no. 8
    
9.
Hrdlicka A. Lower jaw: Double condyles. Am J Phys Anthropol 1941;28:75-89.  Back to cited text no. 9
    
10.
Quayle AA, Adams JE. Supplemental mandibular condyle. Br J Oral Maxillofac Surg 1986;24:349-56.  Back to cited text no. 10
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11.
Zohar Y, Laurian N. Bifid condyle of the mandible with associated polythelia and manual anomalies. J Laryngol Otol 1987;101:1315-9.  Back to cited text no. 11
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12.
Dennison J, Mahoney P, Herbison P, Dias G. The false and the true bifid condyles. Homo J Comp Human Biol 2008;59:149-59.  Back to cited text no. 12
    
13.
Cho BH, Jung YH. Nontraumatic bifid mandibular condyles in asymptomatic and symptomatic temporomandibular joint subjects. Imaging Sci Dent 2013;43:25-30.  Back to cited text no. 13
[PUBMED]    
14.
Aber EP. Bilateral bifid mandibular condyles. J Craniomandib Pract 1987;5:191-5.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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