Morphological and degenerative changes in a suspected post-traumatic bifid mandibular condyle

Bifid mandibular condyle is a rare anatomical anomaly with uncertain aetiology and pathogenesis. Theories for the developmentof this condition include bony alterations post-trauma, however little evidence exists to support this theory. Furthermore, the likely alterations to joint morphology over time as a result of this condition - including possible degenerative changes - have notbeen highlighted. We describe a case of bifid mandibular condyle attributed to a post-traumatic aetiology with associated degenerative changes in a male Sri Lankan skull of approximately 40 to 50 years of age. Fractures of the left parietal bone, zygomatic bone and damage to the orbit were observed in addition to a bifid left mandibular condyle that had anteromedial and posterolateral condyles and remodeling of the mandible consistent with a fracture of the mandibular neck. Two fossae were notedin the squamous part of the temporal bone that corresponded to the two condyles. Degenerative alterations to both joint surfaces included damage to the articular surface and osteophyte formation around the articular margins. This case provides circumstantial evidence to support the development of bifid mandibular condyles post-trauma with observations including longterm modifications to temporomandibular joint morphology leading to subsequent alterations in masticatory muscle activity, andthe first evidence of degenerative change associated with this condition. Both outcomes will potentially result in a loss in temporomandibular joint function and are clinically relevant consequences of bifid mandibular condyle

___

  • Szentpetery A, Kocsis G, Marcsik A. The problem of the bifid mandibular condyle. J Oral Maxillofac Surg 1990;48:1254–7.
  • Dennison J, Mahoney P, Herbison P, Dias G. The false and the true bifid condyles. Homo 2008;59:149–59.
  • Lopez-Lopez J, Ayuso-Montero R, Salas EJ, Rosello-Llabres X. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cranio 2010;28:136–40.
  • Loh FC, Yeo JF. Bifid mandibular condyle. Oral Surg Oral Med Oral Pathol 1990;69:24–7.
  • Menezes AV, de Moraes Ramos FM, de Vasconcelos-Filho JO, Kurita LM, de Almeida SM, Haiter-Neto F. The prevalence of bifid mandibular condyle detected in a Brazilian population. Dentomaxillofac Radiol 2008;37:220–3.
  • Gundlach KK, Fuhrmann A, Beckmann-Van der Ven G. The dou- ble-headed mandibular condyle. Oral Surg Oral Med Oral Pathol 1987;64:249–53.
  • Isik D, Sunay M, Bekerecioglu M. A case of bifid mandibular condyle causing mandibular dislocation. Eastern J Med 2011;16: 87–9.
  • Zohar Y, Laurian N. Bifid condyle of the mandible with associat- ed polythelia and manual anomalies. J Laryngol Otol 1987;101: 1315–9.
  • McCormick SU, McCormick SA, Graves RW, Pifer RG. Bilateral bifid mandibular condyles. Report of three cases. Oral Surg Oral Med Oral Pathol 1989;68:555–7.
  • Stefanou EP, Fanourakis IG, Vlastos K, Katerelou J. Bilateral bifid mandibular condyles. Report of four cases. Dentomaxillofac Radiol 1998;27:186–8.
  • Alpaslan S, Ozbek M, Hersek N, Kanli A, Avcu N, Firat M. Bilateral bifid mandibular condyle. Dentomaxillofac Radiol 2004; 33:274–7.
  • Antoniades K, Hadjipetrou L, Antoniades V, Paraskevopoulos K. Bilateral bifid mandibular condyle. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:535–8.
  • To EW. Mandibular ankylosis associated with a bifid condyle. J Craniomaxillofac Surg 1989;17:326–8.
  • Daniels JS, Ali I. Post-traumatic bifid condyle associated with tem- poromandibular joint ankylosis: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:682–8.
  • Sales MAO, Oliveira JX, Cavalcanti MGP. Computed tomography imaging findings of simultaneous bifid mandibular condyle and temperomandibular joint ankylosis: case report. Braz Dent J 2007; 18:74–7.
  • Miloglu O, Yalcin E, Buyukkurt M, Yilmaz A, Harorli A. The fre- quency of bifid mandibular condyle in a Turkish patient popula- tion. Dentomaxillofac Radiol 2010;39:42–6.
  • Ghigi G, Pastremoli A, Giuliani-Piccari G, Ruggeri F. Anatomic and radiological observations of the bifid mandibular condyle. Radiol Med 2001;101:152–6.
  • Cowan DF, Ferguson MM. Bifid mandibular condyle. Dentomaxillofac Radiol 1997;26:70–3.
  • Jordana X, Garcia C, Palacios M, Chimenos E, Malgosa A. Bifid mandibular condyle: archaeological case report of a rare anomaly. Dentomaxillofac Radiol 2004;33:278–81.
  • Li Z, Djae KA, Li Z-B. Post-traumatic bifid condyle: the patho- genesis analysis. Dent Traumatol 2011;27:453–4.
  • Antoniades K, Karakasis D, Elephtheriades J. Bifid mandibular condyle resulting from a sagittal fracture of the condylar head. Br J Oral Maxillofac Surg 1993;31:124–6.
  • Tunçbilek G. Bifid mandibular condyle: a rare disorder. J Craniofac Surg 2006;17:1207–9.
  • Acikgoz A. Bilateral bifid mandibular condyle: a case report. J Oral Rehab 2006;33:784–7.
  • Ramos FMM, Filho JOV, Manzi FR, Boscolo FN, Almeida SM. Bifid mandibular condyle: a case report. J Oral Sci 2006;48:35–7. Correspondence to: George J. Dias, MS, PhD Department of Anatomy, University of Otago, POBox 56, Dunedin 9013, New Zealand Phone: +64.3.479.7092 Fax: +64.3.479.7254 e-mail: george.dias@otago.ac.nz Conflict of interest statement: No conflicts declared.