Bifid Condyle Research Articles

Assessment of condylar changes in patients with temporomandibular joint pain using digital volumetric tomography.

Objective. To evaluate the efficiency of DVT in comparison with OPG in the assessment of bony condylar changes in patients of TMJ pain. Methods. 100 temporomandibular joints of 62 patients with the complaint of temporomandibular joint pain were included in the study. DVT and OPG radiographs were taken for all the 100 joints. Three observers interpreted the DVT and OPG radiograph for the bony changes separately for two times with an interval of one week. The bony changes seen in the condyle were given coding from 0 to 6. (0: Normal, 1: Erosion, 2: Flattening, 3: Osteophyte, 4: Sclerosis, 5: Resorption, and 6: other changes). Interobserver and intraobserver variability was assessed with one-way ANOVA statistics. Z test was used to see the significant difference between OPG and DVT. Results. In the present study the interexaminer reliability for OPG and DVT was 0.903 and 0.978, respectively. Intraexaminer reliability for OPG and DVT was 0.908 and 0.980, respectively. The most common condylar bony change seen in OPG and DVT was erosion followed by flattening and osteophyte. There was significant difference between OPG and DVT in detecting erosion and osteophytes. The other changes observed in our study were Ely's cyst, pointed condyle, and bifid condyle. All the bony changes are more commonly seen in females than males. Conclusion. DVT provides more valid and accurate information on condylar bony changes. The DVT has an added advantage of lesser radiation exposure to the patient and cost effectiveness and could be easily accessible in a dental hospital.

Nontraumatic bifid mandibular condyles in asymptomatic and symptomatic temporomandibular joint subjects

PurposeThis study was performed to determine the prevalence of bifid mandibular condyles (BMCs) in asymptomatic and symptomatic temporomandibular joint (TMJ) subjects with no traumatic history, and to assess their impact on clinical and radiographic manifestations of TMJ.Materials and MethodsA total of 3,046 asymptomatic and 4,378 symptomatic patients were included in the study. Cone-beam computed tomography (CBCT) images were reviewed for bifid condyles. T-tests were used to compare the frequency of BMCs when stratified by symptom, gender, and side. In BMC patients, the clinical features of pain and noise, osseous changes, and parasagittal positioning of the condyles were compared between the normally shaped condyle side and the BMC side using chi-squared tests.ResultsFifteen (0.49%) asymptomatic and 22 (0.50%) symptomatic patients were found to have BMCs. Among the bilateral cases, the number of condyles were 19 (0.31%) and 25 (0.29%), respectively. No statistically significant differences were found between asymptomatic and symptomatic patients, between female and male patients, or between the right and left sides (p>0.05). Compared with the normally shaped condyle side, the BMC side showed no statistically significant differences in the distribution of pain and noise, parasagittal condylar position, or condylar osseous changes, with the exception of osteophytes. In the symptomatic group, osteophytes were found more frequently on the normally shaped condyle side than the BMC side (p<0.05).ConclusionBMCs tended to be identified as an incidental finding. The presence of BMC would not lead to any TMJ symptoms or cause osseous changes.

Bifid and trifid condyle: report of a case and radiographic diagnosis

Bifid and trifid condyle: report of a case and radiographic diagnosis

Bilateral bifid mandibular condyles diagnosed with three-dimensional reconstruction

Bifid mandibular condyles (BMCs) are rare anomalies. The overwhelming majority of prior reports described their predominantly unilateral occurrence diagnosed by panoramic radiography. We present an even rarer case of bilateral BMC initially identified by panoramic radiography and confirmed with colour-enhanced three-dimensional CT. These images substantiate the theory that the secondary condyles arise from the neck of the mandible (Lopez-Lopez et al. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cianio 2010; 28: 136-140).

Magnetic resonance imaging findings of true bifid mandibular condyle with duplicated mandibular fossa

Bifid mandibular condyle (BMC) is a rare asymptomatic morphological alteration with no predilection for age group or gender. Its morphology varies from a shallow groove to two condylar heads with separate necks, oriented mediolaterally or anteroposteriorly. This report describes an unusual case of anteroposterior bifid condyle in a 39-year-old female patient with the main complaint of mouth-opening limitation and a deviation of the mandible to the left side. Magnetic resonance imaging (MRI) findings revealed a bifid condyle on the left side and duplicated mandibular fossa, with the articular disc over the anterior head. The MRI images in the open-mouth position revealed minimal movement of the condyle. Despite the increased number of mediolateral bifid mandibular condyle cases described in the literature, none of previously reported cases of BMC included an anteroposterior bifid condyle case with two distinct mandibular fossa.

Treatment of unilateral bifid condyle resection using a maxillary guidance ramp: A clinical report

When the condyle is lost, guidance therapy may be required to achieve an improved alignment and function. To achieve an optimum occlusion, maxillary fixation or usage of either palatal guiding ramps or mandibular guiding ramps are generally the treatment of choice. The present case with a bifid condyle resection discusses about achieving an acceptable maxillomandibular relation within a period of 6 months, using a maxillary guidance ramp.

Nontraumatic Bilateral Bifid Condyle and Intermittent Joint Lock: A Case Report and Literature Review

trauma cannot be evidenced in all traumatic cases, with possible trauma at young ages being suggested. Some investigators have suggested that the mediolateral condylar position is associated with a nontraumatic etiology, whereas the anteroposterior condylar position is associated with a traumatic origin. 10 Asymptomatic BMC is usually associated with a nontraumatic etiology, being detected by routine dental examination for other issues. There have been reported cases of symptomatic BMC in the literature, most of which have been associated with ankylosis 11

Post-traumatic bifid condyle: the pathogenesis analysis

This study investigated the characteristic of bifid condyle secondary to temporomandibular joint (TMJ) trauma, aiming to analyse the pathogenesis of post-traumatic bifid condyle. Four cases identified as having bifid condyle secondary to TMJ trauma were involved in this study. The relative information extracted from the case records included patients' complaint, history of injury and radiographic appearance, which were used to analyse the characteristic and pathogenesis of post-traumatic bifid condyle. The results indicated that there was a correlation between condylar trauma degree and bifid condylar head appearance after trauma. For severe condylar fracture, it might result in Y-shaped condyle associated with TMJ ankylosis; and condylar groove could be associated with the slight trauma in condyle articulating surface. In conclusion, as a specific entity, post-traumatic bifid condyle may develop in cases with insufficient remodelling capacity after condyle trauma, and it seems that the severity degree of trauma, the site of trauma and its relation to the insertion of the lateral pterygoid muscles are factors associated with the appearance and orientation of bifid condyle.

Morphologic features of the fetal mandibular condyle: Layers, canals and microvascular pattern

During organogenesis the mandibular condyle is divided by a fibrovascular septum, the persistence of which in the growing cartilage can lead to a bifid condyle. In this study we have evaluated the morphology of 3rd trimester human fetal temporomandibular (TMJ) specimens in order to determine the pattern of the vascular morphology associated with the layers and vascular canals (VCs) of the developing condyle (covering layers and condyle proper). Eleven human fetuses of 27-38cm crown-rump length were used for histological (hematoxylin-eosin, Van Gieson stain) and immunohistochemical evaluation (antibodies for bcl2 and CD34) and another two of 24 and 31cm, for TMJ microvasculature studies after black ink injections. With increasing fetal age, the intermediate loose lamina (LL) of the condylar proliferative layer evolves from a vascular-mesenchymal to a fibrillar pattern, via a transitory stage of a clear space that may be misdiagnosed as lower joint cavity (LJC). Within the condyle proper VCs may be present on its entire sagittal length, deepening variably towards the erosive zone and opened superiorly in the LL loose layer. Vessels of the evolving LL enter the condyle, directly or through the VCs; these vessels retract peripherally with increasing age and the intrinsic vessels of the condyle supplied from the erosive zone become prevalent. Vascular morphogenesis at the level of the LL seems comparable to that at the level of the LJC where characteristic glomeruli regress with increasing age. Lack of vascular regression and closure of central V-shaped defects of the condyle, as observed in 2/22 condyles, may represent a developmental substrate for condylar bifidism or a predisposing condition weakening the condyle, and making it more sensitive to trauma in childhood.

Evaluation of Fractured Condylar Head Along the Sagittal Plane: Report of Three Cases

There are case reports of sagittal fractures of the condylar head leading to bifid condyle. However bifid condyles maybe found in patients with no history of trauma. A split in the saggital plane of the condyle is not visible with a lateral, oblique or panaromic radiographs but only with anteriorposterior, transorbital projections or CT scan of the temperomandibular joint. The chances of condyle being split in the sagittal plane may be due to the medial pole extending beyond the condylar neck, moreover the condyle is composed of cancellous bone covered by a thin layer of cortical bone. Here we are presenting three case reports of Saggital split condyles and stress the need for inclusion of these type of fractures in the classification of condylar fractures.

Incidental findings in maxillofacial region detected by cone beam computed tomography

The purpose of this study was to determine the location, nature, and occurrence of incidental maxillofacial findings on cone beam computed tomography (CBCT) scans performed for maxillofacial diagnostic purposes. CBCT images of 207 consecutive patients (129 females and 78 males) were examined. The sample consisted of 85 temporomandibular joint (TMJ) disorder patients, 45 paranasal sinusitis patients, 30 obstructive sleep apnea syndrome patients, 15 implant patients, and 32 others. The overall rate of incidental findings was 92.8%. The highest rate of incidental findings was in the airway area (51.8%), followed by impacted teeth (21.7%), TMJ findings (11.1%), endodontic lesions (4.3%), condensing osteitis (1%), and others (2.9%). The airway incidental findings included mucosal thickening (21.3%), deviation of the nasal septum (12.6%), conchal hypertrophy (11.1%), bullous concha (3.9%), and retention cysts (2.9%). The impacted teeth consisted of third molars (18.8%) and canines (2.9%). The incidental findings for the TMJ patients were erosion of the condyle (4.8%), osteophytes (3.4%), and bifid condyle (2.9%). Oral radiologists should be aware of possible incidental findings and should be vigilant about comprehensively evaluating possible underlying diseases.

Bifidité du condyle mandibulaire : position du condyle surnuméraire

Bifid condyles are uncommon and include post-traumatic aberrant reorganization of the temporomandibular joint (TMJ) and congenital forms. We report two cases of unilateral bifid condyles, responsible for functional dysfunction of the TMJ. The first case, probably of congenital origin, was oriented frontally. The second case, oriented in the sagittal plane, was probably post-traumatic. Functional treatment was used for both patients. Bifid condyles is asymptomatic in most cases. Their most frequent clinical consequence is TMJ pain. Surgical treatment is rarely indicated. Determining the congenital or post-traumatic origin of bifid condyles is often difficult. The orientation of the supernumerary condyle head could help for the etiological diagnosis.

Aetiology of bifid condyle

Free AccessLetter to the editorAetiology of bifid condyleP P JajuP P JajuSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/dmfr/32282722SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutIn reference to the article “The frequency of bifid mandibular condyle in a Turkish patient population” published in Dentomaxillofacial Radiology,1 I wish to congratulate the authors for an informative study. Bifid mandibular condyle is a rare abnormality of unknown aetiology. The authors took great effort in mentioning multiple aetiologies of bifid condyle, for example, endocrine disturbances, exposure to teratogens, nutritional deficiencies, infection, radiation, trauma and genetic induced. In addition to the numerous aetiological factors described in the article I wish to elaborate some theories not mentioned.Poswillo et al2 suggested that it occurs as a result of changes in the position or form of the disc, leading to the formation of intraarticular septa across the joint space. This, in turn, influences the pattern of condylar regeneration. Post fracture healing and remodelling of the mandibular condyle, if they involve lateral and medial fragments, have also been linked to the development of ankylosis or bifid mandibular condyle. Szentpetery et al3 stated that the site of fracture and, most probably, its relation to the insertion of the lateral pterygoid muscle may determine future development of a normal or bifid condyle. Gundlach et al4 experimentally induced bifid condyles in animals by injecting teratogenic substances such as, N-methyl-N-nitrosourea and formhydroxamic acid in different concentrations at various stages of pregnancy. In addition, some reports of bifid mandibular condyle have established a relationship between the origin of the condition and the glenoid fossa. In developmental bifid mandibular condyle there is a separate glenoid fossa for each of the two parts, while in traumatic bifid mandibular condyle there is only one glenoid fossa.5 I hope these further possible explanations of the various theories adds to our knowledge of bifid condyle.References1 Miloglu O , Yalcin E , Buyukkurt MC , Yilmaz AB , Harorli A . The frequency of bifid mandibular condyle in a Turkish patient population. Dentomaxillofac Radiol 2010;39:42–46. Link ISI, Google Scholar2 Poswillo DE . Late effects of mandibular condylectomy. Oral Surg Oral Med Oral Patho 1972;33:500–512. Crossref Medline ISI, Google Scholar3 Szentpetery A , Kocsis G , Marcsik A . The problem of the bifid mandibular condyle. J Oral Maxillofac Surg 1990;48:1254–1257. Crossref Medline ISI, Google Scholar4 Gundlach KK . Formhydroxamic acid-induced malformations of the temporo-mandibular joint. J Oral Maxillofac Surg 1983;11:121–123. Google Scholar5 Stadnicki G . Congenital double condyle of the mandible causing temporomandibular joint ankylosis: report of case. J Oral Surg 1971;29:208–211. Medline, Google Scholar Previous article FiguresReferencesRelatedDetailsCited byMultiheaded mandibular condyles26 July 2022 | Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie, Vol. 46Bifid condyle secondary to traumatic condylar fractureJournal of Oral and Maxillofacial Surgery, Medicine, and Pathology, Vol. 26, No. 4Nontraumatic Bilateral Bifid Condyle and Intermittent Joint Lock: A Case Report and Literature ReviewJournal of Oral and Maxillofacial Surgery, Vol. 69, No. 8 Volume 39, Issue 4May 2010Pages: 191-256 2010 The British Institute of Radiology History Published onlineJanuary 28,2014 Metrics Download PDF

CÓNDILOS BIFIDO Y TRÍFIDO EN DISFUNCION DE LA ARTICULACIÓN TÉMPORO-MANDIBULAR: REPORTE DEDOS CASOS CLÍNICOS

Bifid or trifid condyle is a rare morphological alteration of the temporomandibular joint (TMJ), of unknown etiology. The aim of this paper is to descri- be 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 noi- se, click and unilateral TMJ pain radiated to the ear in addition to chronic progressive joint hypomobility, underwent CT and MRI 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 tempo- ral 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 of synovitis in the anterior supradiscal recess. Both joint surfaces were covered with fibrocartilage of homogeneous appea - rance 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.

Bifid mandibular condyle with ankylosis in a 3-year-old child: A rare presentation and review

Bifid mandibular condyle with ankylosis is an extremely rare condition and may arise as a developmental or traumatic defect. It may be associated with ankylosis. We here report a case of unilateral bifid mandibular condyle with ankylosis in a 3-year-old child. This is the youngest patient reported with the condition making it one of its first kind in the literature. The detailed description of the case, its radiological findings, and the literature on bifid condyles are reviewed.

The frequency of bifid mandibular condyle in a Turkish patient population

The objective of this study was to investigate the frequency and pattern of bifid mandibular condyles (BMCs). A retrospective study was performed using panoramic radiographs from 10 200 patients undergoing dental treatment in the Department of Oral and Maxillofacial Radiology (Erzurum, Turkey) between 1996 and 2008. Of the 10 200 patients, 32 (0.3%) had BMCs, of whom 17 were female (53.1%) and 15 were male (46.9%). The age range of the patients with BMCs was 5 to 71 years (mean age 30.0+/-0.40). Of these 32 patients, 24 (75.0%) had unilateral and 8 (25.0%) had bilateral BMCs, none of the patients had a history of trauma. No symptoms associated with bifid condyles were observed in any of the patients with BMCs. It is possible that BMC is a more frequent condition than is commonly perceived. However, because of the minimal symptoms associated with this condition, the authors believe that it will remain an incidental finding upon routine radiographic examination, rather than a clinical observation. Nevertheless, in symptomatic cases or in cases where surgical treatment is planned, panoramic radiographs should be supplemented with CT.

The false and the true bifid condyles

The bifid mandibular condyle has been described as a condition of unknown ætiology and uncertain pathogenesis. Many see it as the product of accidental trauma or forceps delivery, with the two heads occurring one behind the other in the sagittal plane. In bioanthropological literature, “bifid condyle” often describes pitting in the sagittal plane, dividing the condyle mediolaterally. We examined 38 male and 16 female pre-European-contact Pacific islanders’ adult mandibles, and 24 male and 29 female modern Indian mandibles, recording frequency, prominence and position of any condylar groove in both coronal and sagittal planes. We report the tenth known case of a bilaterally-bifid condyle. A groove was found almost twice as likely to occur on the left condyle of the Indians than of the Pacific Islanders, but equally likely to occur on the right side of both groups. That same finding applied to males and females. In order to avoid terminological ambiguity, we suggest that the term “bifid condyle” should be reserved for describing multiple condyles in the sagittal plane only – the true bifid condyle. An hypothesis is offered for the occurrence of the groove in the sagittal plane.

Poster 282: Bifid Mandibular Condyle With No History of Trauma or Pain: Case Report

Bifid condyles were reported as rare skeletal anomalies from studies done on human remains. There is a strong correlation of condylar head remodeling and bifid condylar head appearance after trauma. If the trauma factor is eliminated, the possible developmental origin of the bifid condylar head needs to be explored with the asymptomatic patient. With the daily use of dental panoramic radiographs, incidental findings of bifid condyles have given researchers greater opportunities to investigate questions that have remained about etiology and epidemiology into these unusual findings.

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.

Bifid Mandibular Condyle

Bifid mandibular condyle is a rare disorder and little is known about the etiology and pathogenesis. We reported a patient with left bifid mandibular condyle with a history of trauma. There was no limitation of mouth opening but the patient was complaining of pain while chewing. Underdeveloped lateral head of the bifid condyle was excised at the level of condylar neck under general anesthesia. The patient healed without any problem. Microscopic evaluation of the excised condyle supported a congenital etiology. Although most cases of the bifid condyle discovered by chance it should be recognized and treated by plastic surgeons interested in craniomaxillofacial surgery.