Bilateral bifid mandibular condyle: a case report

Bilateral bifid mandibular condyle is a rarely seen malformation. The aetiology of bifid condyle is not completely understood, although developmental anomaly, traumas, condylar fracture, teratogenic embryopathy and surgical condylectomy may all be causative factors. Although a few studies on human dried skulls tried to shed light on this entity it remains obscure. As most bifid condyle subjects have no complaint related to temporamandibular joint(TMJ), the cases are generally diagnosed through incidental radiographic findings. The case of a 54-year-old female is presented. In a panoramic radiograph obtained after a clinical examination, bilateral bifid mandibular condyle was observed. The open-closed lateral radiograph of the TMJ (obtained using the TMJ-specific program of the panoramic device) demonstrated duplication of the right and left condyles. In order to better evaluate the TMJ morphology and to eliminate pathologies such as fractures that might be missed with conventional radiographs, a computed tomography scan was also obtained. The joint head orientation was observed in the mediolateral direction. The case is discussed in the context of the relevant literature. Until large population-based studies are undertaken and further experimental studies are performed, bifid condyle will remain an incidental finding of anatomic variation rather than a clinically informative observation.     

Bifid mandibular condyle: a case report

Abstract –  A case of left bifid mandibular condyle (BMC) is reported in a 36-year-old female. The patient had a history of trauma in childhood. From the radiological examination, the left condyle was seen to have two anterioposteriorly situated heads. BMC is an extremely rare condition, where the condyle is duplicated or lobulated. The literature on BMC is reviewed, and possible cause of trauma and consequences of the anomaly are discussed.     

Bifid mandibular condyle: a rare disorder

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.     

外伤致下颌骨髁突颅内移位：病例报告及文献复习

下颌骨髁突颈部结构薄弱,受外力作用时容易折断,从而通过缓冲创伤能量,避免颅中窝及颅脑等重要解剖部位受到损伤,可视为人体的一种自我保护机制。本文报告1例较为少见的髁突颅内移位外伤病例,髁突在未发生骨折的情况下向上移位,突破颅中窝底进入颅内,并结合相关文献,就其发生机制、临床表现、诊断及治疗进行讨论。     

Bilateral Posterior Dislocation of Mandibular Condyle: A Rare Entity in Maxillofacial Injuries

BackgroundDislocation of the mandibular condylar head refers to ectopic positioning of the intact condylar head out of the glenoid fossa. Most commonly reported anterior dislocation results from anteromedial pull of the lateral pterygoid muscle and laxity of the surrounding tissue with advanced age.PurposeThis case report brings forth a unique case of bilateral posterior condylar dislocation in an edentulous patient who reported after 4 weeks of traumatic injury.MethodThe condition was managed surgically by reduction of the dislocated condyle and placement of mersilene tape on one side and temporalis muscle on the other side as anchorage ligament to stabilize the condyle and prevent any future recurrence.ResultsThe patient was maintained on long-term follow-up for up to one year with no reported recurrence or reduction in mouth opening.ConclusionThis is the first ever case report that highlights bilateral posterior dislocation of intact mandible unlike the previous four reports which have brought forth unilateral dislocation on English literature search. Posterior dislocation of mandibular condyle is encountered in edentulous patients who experience posteriorly directed impact which forces the condylar head behind the postarticular ridge. Unlike anterior dislocation, clinical features include reduced mouth opening and retruded mandible in bilateral dislocation. It has been observed that manual correction by pressing the mandible downwards and forwards yields good results in early cases. Cases that are reported late require surgical exploration for reduction and placement of anchorage ligament to prevent recurrence in unstable condyle.     

Supero-lateral dislocation of sagittally split bifid mandibular condyle

A case of supero-lateral dislocation of the mandibular condyle into the temporal fossa is reported. The condyle was concurrently fractured antero-posteriorly forming a bifid mandibular condyle. The previously reported cases of supero-lateral dislocations into the temporal fossa are discussed and the literature of bifid condyle is reviewed.     

Metastatic adenocarcinoma of the mandibular condyle from uterine cervix: Report of a case

Metastasis to the mandibular condyle is rare, and such lesions should be identified by both clinical and pathological examinations. We experienced a case of adenocarcinoma occurring in the right mandibular condyle. A 65-year-old female with uterine cervical cancer showed condylar dysfunction. Imaging examinations revealed a tumor with bone destruction and a rapidly progressive course, while pathological examinations suggested metastasis originating from another site. Based on the clinical and pathological findings, the patient was diagnosed with condylar metastasis derived from the uterine cervix, in addition to a recurrence of uterine cervical cancer.     

Trifid mandibular condyle: A case report

A few cases of bifid, but no case of trifid mandibular condyle, have been reported in the literature. This article presents the first reported case of trifid mandibular condyle in a living subject with a history of previous trauma to the temporomandibular joint (TMJ). Additionally, the patient's other condyle was bifid. The patient had no complaint related to the functions of TMJ except for minimal weakness following chewing. The etiology and the prognosis of bifid and trifid condyle are discussed briefly. We considered computed tomography essential to rule out early stages of TMJ pathology in similar cases that resemble trifid mandibular condyle on conventional radiographs.     

Mandibular ankylosis associated with a bifid condyle

A case of bilateral temporo-mandibular joint (TMJ) ankylosis with a bifid mandibular condyle is reported. The patient had a history of trauma 39 years previously. The right condyle was mushroom-shaped and the left condyle was bifid. The treatment of ankylosis is briefly discussed and the literature on bifid condyles is reviewed.     

Post‐traumatic bifid condyle: the pathogenesis analysis

Abstract – 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.     

Bilateral bifid mandibular condyle: case report and literature review

Bifid mandibular condyle is an infrequent and normally asymptomatic morphological alteration of the mandibular condyle. Although the underlying cause is not clear, a number of theories have been proposed, including teratogenic effects in the embryo, vascular alterations during condyle development, and condylar remodeling following fracture. Since Schier first described this anomaly in 1948 in live individuals, further cases have been documented in the literature. We present a new case of bilateral bifid condyle. The disorder was asymptomatic and constituted a casual finding in a young male presenting for the surgical extraction of two impacted molars.     

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.

Bifid mandibular condyles: report of four cases

Anatomic variations in the condylar morphology, like bifid mandibular condyles, are a relatively uncommon anomaly.We report four cases (two in patients and two in archived specimens) of bifid mandibular condyles with emphasis on their aetiopathogenesis and radiographic features. A case of bifid mandibular condyles in a patient with rheumatoid arthritis is reported which, to the best of our knowledge, is the first reported case in the literature. CLINICAL RELEVANCE: Anatomical variations, like bifid mandibular condyles, may mimic a fracture/tumour. Therefore, knowledge and awareness about this entity is important for a general dental practitioner.     

下颌持续前导对成年大鼠髁突软骨骨形态发生蛋白表达及超微结构的影响

目的 观察成年期大鼠在下颌持续前导作用下髁突软骨的改建以及超微结构的变化。方法 将30只9周龄SD大鼠随机分为实验组和对照组,实验组佩戴上颌斜面导板,对照组不做任何处理,分别在第3、7、14、21、30天处死动物并取材,免疫组织化学染色检测骨形态发生蛋白2（BMP-2）在髁突中的表达及分布,透射电镜观察髁突软骨细胞的超微结构,Micro CT分析髁突骨质的变化。结果 与对照组相比,实验组髁突中部和后部软骨增生明显,软骨细胞BMP-2阳性细胞率及灰度值在第7天开始增多,随时间延长而增强,髁突软骨细胞的超微结构出现细胞核固缩,核周微丝变少、脂滴变小、内质网腔隙肿胀、细胞外基质增宽变多等。Micro-CT显示实验组的新生骨和骨小梁厚度、骨小梁数量和分离度随时间延长而增加。结论 在下颌持续前导下,成年期大鼠髁突软骨出现增生性改建,并存在BMP-2的高表达。     

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.     

Mirror image condylar hyperplasia in two siblings

A Hispanic family with an unusual clinical and radiological pattern of condylar hyperplasia is presented. Mirror images of condylar hyperplasia, malocclusion of teeth, and shift of midline of the mandible were seen in two brothers. The father had a similar abnormality of his left mandibular condyle. The condylar hyperplasia in this family indicates that mandibular condylar hyperplasias could be genetic in origin, possibly Y-linked or autosomal dominant.     

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??Objective??An animal model of condylar cartilage and subchondral bone injury during growing period is established??and three-dimensional measurement of mandibular was performed with Materialise Proplan CMF 3.0 software to investigate the effect of PRP on repairing condylar cartilage and maintaining mandibular growth in growing period. Methods??Thirty growing New Zealand white rabbits were randomly divided into three groups. The PRP group animals ??10?? were implanted in activated PRP after the establishment of the animal model of condylar cartilage and subchondral bone injury.The condylar cartilage and subchondral bone injury models were established in the operation group ??10??. The sham operation group ??10?? was similar to the operation group except for the condylar cartilage and subchondral bone injury. At 6 and 12 weeks after surgery the animals received spiral computed tomography??and SPCC data were collected.Maxillary and mandibular three-dimensional reconstruction was performed using Materialise Proplan CMF 3.0. The upper and lower jaws were separated and the morphology of condylar was completely revealed. The result of measurement are analysed with statistical method after the determining the marking points??reference planes and corresponding measurement indexes. Results??The indexes of the operation group were all smaller than those of the sham operation group and the PRP group at each time point??P < 0.05????6 weeks after surgery??the height of mandibular ramus??the length of condyle and the width of condyle in PRP group were less than those in sham operation group??P < 0.05??. There was no significant difference in mandibular length or condylar height between PRP group and sham operation group ??P > 0.05??. The mandibular ramus height and mandibular body length in PRP group were less than those in sham operation group at 12 weeks after operation??P < 0.05??. There was no significant difference in condylar height??length or width between PRP group and sham operation group ??P > 0.05??. Conclusion??After the injury of mandibular condylar cartilage??the growth and development of mandibular are relatively stagnant??and the mandibular condyle is absorbed. Activated PRP can effectively repair the injury of condylar cartilage during growing period??promote the normal growth and development of mandible and condyle??and maintain the normal shape of mandible.     

Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysis

The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. The base population from which patients were recruited was reported in 57 studies (45%). The reason for TMJ prosthesis implantation was reported for 4177 patients (29.0%). A history of condylar fracture was present in 83 patients (2.0%); a history of mandibular trauma was present in 580 patients (13.9%). The meta-analysis showed a pooled prevalence of condylar fracture of 1.6% (95% confidence interval 0.9–2.4%) and a pooled prevalence of trauma or condylar fracture of 11.3% (95% confidence interval 7.1–16.0%). Heterogeneity was highly significant (P < 0.001). The TMJ prosthesis appears to be reserved for patients with persistent pain, bony or fibrous ankylosis, or osteomyelitis after primary closed or open treatment of fractures of the mandibular condyle.     

Bilateral Bifid Mandibular Condyles

The bifid mandibular condyle is, in and of itself, a most uncommon anatomic occurrence. The observation of bilateral bifid mandibular condyles is, in fact, rare. Hrdlicka¹ first described three cases of this bilateral phenomenon in 1941 in the American Journal of Physical Anthropology. Since then, there have been no known reported cases of bilateral bifid mandibular condyles.

This paper reports a case of documented bilateral bifid mandibular condyles diagnosed in a young woman undergoing routine temporomandibular joint evaluation following a trauma to the face.