Bifid condyle: Case report

Corchero Martín, Guadalupe; Gonzalez Terán, Tomás; García Reija, María Fe; Sánchez Santolino, Sergio; Saiz Bustillo, Ramón

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Medicina Oral, Patología Oral y Cirugía Bucal (Ed. impresa)

Print version ISSN 1698-4447

Med. oral patol. oral cir. bucal (Ed.impr.) vol.10 n.3 May./Jul. 2005

Bifid condyle: Case report
Cóndilo bífido: A propósito de un caso

Guadalupe Corchero Martín⁽¹⁾, Tomás Gonzalez Terán ⁽¹⁾, María Fe García Reija ⁽²⁾, Sergio Sánchez Santolino ⁽¹⁾,
Ramón Saiz Bustillo ⁽³⁾

(1) Médico Residente
(2) Médico Adjunto
(3) Jefe de Servicio. Cirugía Maxilofacial H.U. Marqués de Valdecilla (Santander)

Address:
Guadalupe Corchero Martín
Hospital Universitario Marqués de Valdecilla
Avd.Valdecilla s/n
C.P.39008
Teléfono:942202528
Fax:942202726
E-mail:guacorch@yahoo.es

Received: 18-07-2004 Accepted: 4-2-2005

Corchero-MartínG, Gonzalez-Terán T, García-Reija MF, Sánchez-Santolino S, Saiz-Bustillo R. Bifid condyle: Case report. Med Oral Patol Oral Cir Bucal 2005;10:277-9.
© Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-4447

SUMMARY

The double headed mandible condyle is a rare alteration that is frequently diagnosticated as an incidental finding in a panoramic radiograph. The different theories about its etiology are explained in this article. Symptoms described with bifid condyles vary from case to case, but in most instances are absent. Computer tomography is the ideal imaging method to evaluate the condyle morphology and to role out any degenerative process to achieve the differential diagnosis. Treatment is conservative for symptomatic patients with TMJ disorders, surgical treatment is described in literature in TMJ ankylosis that develops in bifid condyles secondary to trauma.

Key words: Bifid condyle, double headed condyle, condylar duplication.

RESUMEN

En este artículo, a propósito de un caso clínico, se presenta el cóndilo bífido como una rara alteración mandibular con muchas incógnitas. Su diagnóstico suele ser un hallazgo casual en radiografías panorámicas de rutina. El número de casos relatados en literatura ha experimentado en los últimos años un crecimiento debido al aumento de pruebas radiológicas que se realizan. Se discute sobre las diferentes teorías existentes con respecto a la etiología de este proceso. En lo referente a la relevancia clínica del cóndilo bífido señalamos que la gran mayoría son asintomáticos. Es importante realizar un buen diagnóstico diferencial de éste proceso con otras lesiones que producen alteraciones morfológicas condilares, la prueba de elección es la tomografía computerizada. El tratamiento conservador suele ser efectivo en los casos con clínica de disfunción articular leve, la cirugía tan sólo suele indicarse en casos de anquilosis condilar, normalmente éstos casos son secundarios a traumatismos.

Palabras clave: Cóndilo bífido, duplicación condilar.

INTRODUCTION

Bifid mandibular condyle is an abnormality that is it repeatedly diagnosticated as an incidental finding in a panoramic radiograph.

This deformity was first described in literature by Hrdlicka in 1941 (1) in the American Journal of Physical Anthropology.

The double headed mandibular condyle does not appear to have any predilection for any particular race or gender. Cases are unilaterals and asymptiomatics (2).

The etiology and epidemiology are unknown. It is postulated that an embryonic or developmental alteration should produce this bifid shape (3).

From the angle of symptoms the majority of the patients have no TMJ complaints.

CASE REPORT

A 42-year-old woman was referred to our Oral and Maxillofacial Department at Marqués de Valdecilla University Hospital in Santander (Spain) with a complaint of pain and clicking on her right mandibular joint. Patient denied having had any previous trauma or fractures of the mandible.

Her physical examination showed no skeletal relationships alteration. Mouth opening was normal, protrusive and lateral excursions were respected.

A panoramic radiograph was performed and showed an abnormal left condyle.(Fig.1).In order to complete the studio a magnetic resonance imaging (MRI) (Fig. 2) was achieved and was informed as an anterior displacement of the right condyle that recapture with mouth opening, on the left condyle an anteroposterior bifid shape was described.

Computer tomography (CT) of both joints was taken to rule out early stages of temporomandibular joint (TMJ) pathology and showed a bifid condyle with no degenerative sings (Fig.3).

Treatment was conservative with a occlusal splint, soft diet, anti-inflammatories and muscle relaxants. The symptoms regressed and she is being reviewed in our Maxillofacial Department.

DISCUSSION

Bifid mandibular condyle is a rare bone deformity .

The etiology of the double headed condyle is confused and literature consider a large number of postulations. One of the theories explains that a trauma may produce after the condyle remodelling a bifid shape. Developmental origin is suggested by other authors like teratogenic substances, endocrine disorders, nutritional deficiency, infection, trauma, irradiation and genetic factors that could altered the right development (4). Blackwood tried to explain this deformity by a fibrous septa in the cartilage of the developing condyle process that alter the morphology (5).

Epidemiology of this bone deformity is impossible to know because is an asymptomatic incidental finding. There does not appeared to be a predilection for any age group or either gender.

The double headed condyles are most common diagnosticated by a panoramic radiographies. It is necessary to make the differential diagnosis (6) with other degenerative lesions as tumours, cysts, metastatic or metabolic lesions (7). The ideal method for detailed evaluation of condylar morphology seems to be coronal computed tomography.

Treatment in symptomatic cases is conservative for TMJ disorders. Surgical treatment is described in TMJ ankylosis that used to appeared in bifid condyles secondary to trauma.

BIBLIOGRAFIA [ Links ]

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3. Antoniades K, Hadjipetrou L, Antoniades V, Paraskevopoulos K. Bilateral bifid mandibular condyle. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:535-8. [ Links ]

4. Artvinli LB, Kansu O. Trifid mandibular condyle: A case report. Oral Surg Oral Med Oral Pathol 2003; 95:51-4. [ Links ]

5. Gundlach KK, Fuhrmann A, Beckmann-Van der Ven G. The double headed mandibular condyle. Oral Surg, Oral Med, Oral Pathol 1987;64:249-5. [ Links ]

6. Ghigi G, Pastremoli A, Giuliani- Piccari G, Ruggeri F. Anatomic and radiological observations of bifid mandibular condyle. Radiol Med 2001;101:152-6 [ Links ]

7. Hudson JW, Livesay KW, McCoy JM. Condylar lesion. J Oral Surg 2003;61:824-6. [ Links ]