Three-Dimensional Evaluation of Bifid Condyle by Cone-Beam Computed Tomography.

Bifid condyle is a rare developmental anomaly that results from an obstructed blood supply during its development. Bifid condyle is more often unilateral, although bilateral. A case of a bifid condyle is evaluated three-dimensionally in three orthogonal planes namely coronal, sagittal and axial sections. The etiology, clinical features, diagnostic, non-surgical and surgical treatment modalities of bifid condyle are discussed.

Prevalence of the Bifid Mandibular Condyle and Its Relationship with Pathologies of the Temporomandibular Joint: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of this study was to describe the prevalence of anatomical variants in the bifid mandibular condyle (BMC) and report its association with temporomandibular joint (TMJ) pathology. METHODS: We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to September 2023. Two authors independently performed the search, study selection, and data extraction, and they also assessed the methodological quality with an assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. RESULTS: A total of 50 studies met the eligibility criteria. Twenty studies, with a total of 88,625 subjects, were included in the meta-analysis. The overall prevalence of the bifid mandibular condyle (BMC) variant was 1% (95% CI = 1% to 2%). CONCLUSIONS: The correlation between the BMC and TMJ pathologies has a relatively low prevalence in studies that present a considerable number of subjects. From a clinical point of view, a direct association cannot be made between the presence of the BMC and TMJ pathologies or symptoms.

Multiheaded mandibular condyles.

OBJECTIVES: This study aimed to evaluate the prevalence of multiheaded condyles (MHC) in a group of Turkish subjects using cone-beam computed tomography (CBCT). METHODS: In this retrospective study, CBCT scans of 975 patients (546 female, 429 male; age 15-89 years, mean age 42.46 years) who were referred to Istanbul University Faculty of Dentistry, Department of Dentomaxillofacial Radiology between 2015 and 2021 were evaluated. Bifid and trifid mandibular condyle cases were analyzed according to the patients' age, gender, and laterality, and their frequencies were determined statistically. RESULTS: A multiheaded mandibular condyle (MHC) was detected in 57 of the 975 patients (546 female, 429 male). MHC was diagnosed unilaterally in 49 patients; in 8 patients, it was observed bilaterally. A bifid mandibular condyle (BMC) was detected in 54 patients. A trifid mandibular condyle (TMC) was found in 2 women, and one tetrafid mandibular condyle was seen in 1 woman. CONCLUSIONS: The prevalence of MHC was 5.84% in our proband, which is higher than in previous studies. There was no statistically significant difference between the prevalence of MHC in males or females.

Bifid Mandibular Condyle With Associated Temporomandibular Joint Ankylosis: A Rare Skeletal Abnormality.

Bifid mandibular condyle (BMC) is splitting the mandibular condyle into two separate articular surfaces. The etiology is poorly understood, but trauma and developmental issues are currently the most cited causes. Though most often asymptomatic, occasionally, this condition may cause the development of jaw pain, clicking, and restriction of motion. We present a rare case of a patient who developed unilateral ankylosis of the temporomandibular joint (TMJ) secondary to BMC in the absence of trauma or infection. The ankylosis developed due to abnormal biomechanical forces and degenerative arthritis secondary to the abnormal articulation of the TMJ caused due to BMC. CT imaging is the best modality to evaluate the bony anatomy of the TMJ. It is essential to consider BMC as a cause of TMJ pathology, as management is primarily surgical in nature.

Bilateral bifid mandibular condyle associated with ankylosis of the temporomandibular joint in a 6-year-old child.

Bifid mandibular condyle with ankylosis is an extremely rare condition and may arise as a developmental or traumatic defect. We report here a case of bilateral bifid mandibular condyle with ankylosis in a 6-year-old child. The patient had severe limitation of mouth opening and history of trauma 2 years ago.

Multi-headed (bifid and trifid) mandibular condyles in archaeological contexts: Two posttraumatic cases.

OBJECTIVE: Bifid and trifid mandibular condyles are infrequent morphological alterations of the mandibular condyle. With the aim of better identifying its possible causing factors in the past and provide clues on the potential types and severities of joint dysfunction that may occur if clinical intervention is not undertaken, two archaeological cases of multi-headed mandibular condyles are presented, and their possible aetiology and pathogenesis are discussed. DESIGN: In this study, 143 adult mandibles recovered in the northwest of Spain were examined: 91 exhumed from San Juan Bautista church (Guardo, Palencia; 16th-19th centuries), and 52 from San Salvador de Palat de Rey church (León, 13th-19th centuries). All mandibles were observed macroscopically for the presence of any morphological and/or pathological alterations. When justified, the mandibles were also scrutinized through computed tomography. RESULTS: Two isolated mandibles (n = 1, Palencia; n = 1, León) with multi-headed mandibular condyles (bifid and trifid) were identified. The computed tomography scan of the affected mandibles revealed alterations compatible with traumatic events, namely line fractures and deformations at the angle of the mandible. CONCLUSIONS: Both the bifid and trifid mandibular condyles here described probably result from traumatic events during childhood leading to a posttraumatic deformation. Although no severe impairment of mandibular use was identified, some asymmetries probably resulted in some sort of malfunction, with TMJ-OA and gonial angle eversion as supporting evidence. Nevertheless, the degree of bone remodelling observed indicates that both individuals lived long after the traumatic occurrence.

Bifid Mandibular Condyle as the Hidden Cause for Temporomandibular Joint Disorder.

Bifid mandibular condyle is a rare occurrence, more frequently unilateral. The etiology of this condition is controversial. Bifid mandibular condyles of developmental origin are mostly asymptomatic and discovered incidentally through imaging. Here, we report a 38-year-old male patient, previously in good health, presented with progressive pain in his right temporomandibular joint and restricted joint movements. MRI of the bilateral temporomandibular joints revealed mild degenerative disc on the right side and bifid mandibular condyle on the left side. Conservative treatment comprising a series of soft, medium, and hard splint therapy in combination with analgesics showed symptomatic improvement initially but did not improve the condition in the long term. He subsequently underwent arthrocentesis of the right temporomandibular joint and perceived a good clinical improvement until he developed progressive pain in the left temporomandibular joint and radiating to the left side of the face. He underwent partial condylectomy and discopexy following which all of his symptoms improved; which drives us to question if bifid mandibular condyle is the hidden cause for bilateral temporomandibular joint pain.

Bilateral bifid condyles: A rare etiology of temporomandibular joint disorders.

Background: Bifid mandibular condyle (BMC) is a rare etiology of temporomandibular joint (TMJ) disorders characterized by a duplication of the head of the mandibular condyle.Case report: The authors report the case of a 20-year-old patient complaining of a painful and clicking TMJ and mandibular hypomobility, which had been progressing for several months. Radiological investigations (dental panoramic radiograph and X-ray CT scan) revealed right and left abnormalities of the TMJ due to bilateral BMC requiring surgical management.Conclusion: Despite a prevalence of 0.31% to 1.82% and the controversies surrounding its pathophysiology, maxillofacial surgeons should be aware of BMC to avoid misdiagnosis related to the clinical presentation (pain, clicking, hypomobility, or ankylosis) and provide adequate management.

Trifid mandibular condyle: A case report and literature review.

Trifid mandibular condyle is a rare anatomical malformation characterized by a division of the mandibular condylar head. The two articulating surfaces of the bifid condyle are divided by a groove that can be oriented mediolaterally or anteroposteriorly. This anomaly of the mandibular condyle has been described as a condition of unknown ætiology and uncertain pathogenesis. Some authors see it as a result of accidental trauma or forceps delivery, with the two heads occurring one behind the other in the sagittal plane. Reported cases are mostly unilateral and usually asymptomatic. The diagnosis is made after radiographic exploration and precised by advanced imaging techniques such as three-dimensional computerized tomography.

A study on etiopathogenesis and clinical features of multi-headed (bifid and trifid) mandibular condyles and review of the literature.

PURPOSE: The formations of second or more condylar heads are considered as rare anomalies. Fourteen multi-headed condyles (MHC) were presented; 13 of these were bifid mandibular condyles (BMC), whereas one exceptionally rare case was a trifid mandibular condyle (TMC). The TMC presented in this paper is the eighth case reported in the literature. In this paper, etiopathogenesis, types, and treatments are discussed. MATERIALS AND METHODS: Patients were classified according to their status, etiologies, gender, functions of the mandible, interocclusal distances, pathological conditions, types, and treatment received. RESULTS: BMCs were classified into two groups: type I BMCs were nontraumatic, nonsymptomatic, mediolateral, presumably developmental, and characterized by shallow grooves. Type II BMCs were traumatic and may have two subgroups. The first group of type II BMCs were mediolateral and Y-shaped. The second group of type II BMCs were characterized by two separate and anteroposteriorly located condyles. CONCLUSION: Treatment depended on patients' complaints. In this study, asymptomatic patients did not receive therapy, whereas patients with temporomandibular join internal derangement received medical treatment, and patients with ankylosis had surgical treatment.

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.

Bifid mandibular condyle: a study of the clinical features, patterns and morphological variations using CT scans.

Bifid Mandibular Condyle (BMC) are usually diagnosed on routine radiographic examination, is described in the literature as a rare entity. It is reported that BMC has no predilection by sex or ethnic background or the age. The etiopathogenesis of BMC still remains controversial and proper description of the condition is not defined owing to fewer reported cases. Dental professionals should have some knowledge of this anatomic abnormality, as well as its implications for function and appropriate treatment modalities, so that they can be alert to this potential diagnosis. This paper reports the largest series of BMC, using CT scans with history of trauma and presents some of the characteristic clinical features.

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).