Multiple morphological variations in a human mandible / Múltiples variaciones morfológicas en una mandíbula humana

Bilateral mylohyoid bridging, hyperplasia of the coronoid process and bifid condylar process were detected in a human mandible. It is of great interest that such rare morphological anomalies can occur in the same mandible. Since sound understanding of the anatomical variations of the mandible, in conjunction with a careful pre-operative review of radiographs, are essential in the safe and complete performance of surgical and prosthetic rehabilitation, the authors of the present report believe that this case may add to the existing literature.

En una mandíbula humana se detectó puente milohioideo bilateral, hiperplasia del proceso coronoides y el proceso condilar bífido. Es de interés que se puedan producir dichas anomalías morfológicas en la misma mandíbula. Es esencial un conocimiento sólido de las variaciones anatómicas de la mandíbula, en conjunción con una revisión preoperatoria cuidadosa de las radiografías, en el desempeño seguro y completo de la rehabilitación quirúrgica y protésica. Los autores del presente estudio estiman que este caso puede aportar información a la literatura existente.

Cóndilos bifido y trífido en disfunción de la articulación témporo-mandibular: reporte de dos casos clínicos / Bifid or trifid condyles in temporomandibular joint disorder: report of 2 cases

Abstract: Bifid or trifid condyle is a rare morphological alteration of the temporomandibular joint (TMJ), of unknown etiology. The aim of this paper is to describe the imaging findings of two patients with bifid and trifid mandibular condyle associated with functional disorders. Material and Method: Two female patients, who over the last six months had presented with noise, click and unilateral TMJ pain radiated to the ear in addition to chronic progressive joint hypomobility underwent CTand MR I examinations. Results: A severe asymmetry of mandibular condyles regarding size and shape, along with irregular contours and presence of cracks or channels in condylar apex, were observed. The bone structure of cortical and trabecular bone of the condyles, as well as the condylar bone marrow, had a normal appearance. The morphology of both glenoid fossa and transverse apophysis of the temporal bone was normal. The articular disc presented a deformation adapted to the condylar shape, showing the biggest disc volume as related to the condylar groove; a case with an accumulation of fluid in the superior articular recess, and signs ofsynovitis in the anterior supradiscal recess. Both joint surfaces were covered with fibrocartilage of homogeneous appearance and regular thickness. Conclusions: Changes in condylar morphology deserve special attention in differential diagnosis of bone tumors. It is important for the radiologist to be aware of the extreme anatomic variability of the TMJ. Bifid condyles are affected by TMJ dysfunctions.

El cóndilo bífido o trífido es una rara alteración morfológica de las articulaciones témporo-mandibulares (ATM), de etiología desconocida. El objetivo del presente artículo es describirlos hallazgos imaginológicos de dos pacientes que presentan cóndilo mandibular bífido y trífido, asociado con patologías funcionales. Mediante tomografía computarizada y resonancia magnética se estudiaron dos mujeres que clínicamente presentaban ruidos, resalte y dolor de ATM unilateral irradiado al oído, además de hipomo-vilidad crónica progresiva de la articulación, durante los últimos 6 meses. Se observó severa asimetría de tamaño y forma de los cóndilos mandibulares, con irregularidad de contornos, aparición de hendiduras o canales en ápex condilar. La estructura ósea del hueso cortical y trabecular de los cóndilos mostró aspecto normal, así como también la médula ósea. La morfología glenoidea y de las apófisis transversas del temporal se observaron normales. El disco articular presentó una deformación adaptativa a la forma condilar, observándose el mayor volumen discal en relación a la hendidura condilar, un caso con acumulación de líquido en el receso articular superior y signos de sinovitis en el receso supradiscal anterior. Ambas superficies articulares se observaronn cubiertas de fibrocartílago de aspecto homogéneo y espesor regular. Conclusiones: Las alteraciones de la morfología condilar merecen especial atención para el diagnóstico diferencial con tumores óseos. Es importante para el radiólogo estar atento a la existencia de extrema variabilidad anatómica de la ATM. Los cóndilos bífidos son afectados por disfunciones de la ATM.

Computed tomography imaging findings of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis: case report

Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings.

O côndilo mandibular bífido (BMC) é uma entidade incomum descrita na literatura e de etiologia controversa. Apesar da ausência de sintomatologia clínica, o radiologista deve estar alerta e deve ter conhecimento a respeito desta anormalidade, bem como suas implicações funcionais e mudanças morfológicas. A anquilose de articulação temporomandibular é uma patologia incapacitante com envolvimento do côndilo mandibular, fossa articular e base do crânio. A associação entre côndilo mandibular bífido e anquilose temporomandibular é rara e deve ser avaliada cuidadosamente. O objetivo deste artigo é relatar um caso simultâneo de côndilo mandibular bífido (BMC) e anquilose temporomandibular e descrever seus achados em tomografia computadorizada (CT).