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

Rajashri R,Santhosh P Kumar,Senthilnathan Periasamy

doi:10.7759/cureus.17609

Abstract

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.

Highlights

Bifid mandibular condyle (BMC) is an extremely rare anatomic variation of controversial etiology
With the use of advanced imaging modalities like computed tomography (CT), cone-beam computed tomography (CBCT), and magnetic resonance imaging (MRI), there is an increase in the incidences, accounting for about 0.31% to 1.82% of cases [3]
With the use of advanced imaging modalities such as computed tomography (CT), cone-beam computed tomography (CBCT), and magnetic resonance imaging (MRI), there has been an increase in the number of cases reported with an actual prevalence of about 0.31% to 1.82% [3]

Summary

Introduction

Bifid mandibular condyle (BMC) is an extremely rare anatomic variation of controversial etiology. He experienced tenderness on the right side with restricted mouth opening His previous MRI of the bilateral temporomandibular joint showed signs of mild degenerative changes of the bilateral articular disk with reduced translation on the right side and bifid left mandibular condyle with a small cyst next to the left temporomandibular joint (Figures 2, 3). The muscles of mastication did not show any reproducible pain, and erythema or edema was absent bilaterally He endorsed decreased pain in the right temporomandibular joint following a series of soft, moderate, and hard splint therapy in sequence for a period of four months each on average and in combination with analgesics for two years. MRI revealed impingement of anterior or intermediate disc band caused by the left bifid condyle with minimal anterior translation, and there was evidence of mild degenerative arthropathy in his right temporomandibular joint (Figures 4, 5). There is no evidence of abscess or fluid collection suggesting successful management of the temporomandibular disorder (Figure 12)

Discussion

Conclusions

Findings

Disclosures

Balciunas BA