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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 60-62

Bilateral double-headed condyles: A rare case report


1 Department of Oral Medicine and Radiology, Private Practice, Jind, India
2 Department of Prosthodontics, Private Practice, Jind, India
3 Department of Conservative Dentistry and Endodontics, Private Practice, Rohtak, Haryana, India

Date of Web Publication12-Mar-2018

Correspondence Address:
Swati Phore
Department of Oral Medicine and Radiology, Jind, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjos.SJOralSci_62_17

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  Abstract 


Bifid mandibular condyle is characterized by the duplicity of the head of the mandibular condyle, so the name double-headed condyle. It is usually diagnosed on routine radiographic examination and is described as a rare entity. Usually, bifid condyle is an incidental finding and its etiology is controversial, with no predilection for sex or ethnic background. Herein, we report a case of bilateral bifid condyles.

Keywords: Bifid, bilateral, condyle, mandible


How to cite this article:
Phore S, Singh RR, Malhotra M. Bilateral double-headed condyles: A rare case report. Saudi J Oral Sci 2018;5:60-2

How to cite this URL:
Phore S, Singh RR, Malhotra M. Bilateral double-headed condyles: A rare case report. Saudi J Oral Sci [serial online] 2018 [cited 2018 Aug 15];5:60-2. Available from: http://www.saudijos.org/text.asp?2018/5/1/60/227137




  Introduction Top


The term “bifid” is derived from the Latin word “bifidus” which means cleft into two separate parts. The bifid mandibular condyle (BMC) or double-headed condyle is considered to be a rare pathology of the temporomandibular joint (TMJ) characterized by the duplicity of the head of the mandibular condyle. The articulating surfaces of the bifid condyle are divided by a groove and can be oriented mediolaterally or anteroposteriorly. The anomaly may occur on both sides but is frequently unilateral, apparently without any marked predilection for any one side.

The condylar splitting ranges from a shallow groove to two distinct condyles with a separate neck.[1] Concerning the unilateral bifid condyle, it is found that there is no age predilection. The age of the patients ranges from 3 to 67 years (mean age, 35 years) and the male/female ratio is approximately 1.5:1. Bifid condyles appear to involve the left side more than the right side (15 of 25 cases with available data).[2]

The condition was not cited in the main treatise of skull morphological variants. It was first described by Hrdlicka[3] in 1941 who found 21 cases in the Smithsonian Institution's collection of dried skulls. It is, until now, the most richly illustrated descriptions of this anomaly. After him, Szentpétery[4] found seven BMCs on 1882 prehistoric and historic skulls with 2007 condyles from the collection of Hungarian skulls (Neolithic-18th). The first report of this condition in a living population was made in 1948 by Schier.[5] A second and well-documented report of this abnormality was given by Stadnicki[6] in 1974.

The morphology of the bifidity ranges from grooving to discrete condylar heads, with the orientation running sagittally or coronally. The study of the previous cases seems to suggest that the left condyle is affected twice as often as the right condyle and the most were unilateral cases.[7]

On the other hand, the patient presented here had bilateral bifid condyles.


  Case Report Top


A 55-year-old male patient visited the dental clinic with a complaint of mobility of teeth; he also had a history of bleeding gums. His medical and dental history was noncontributory. On extraoral examination, there was no tenderness in TMJ with no clicking sound. On intraoral examination, mouth opening of the patient was 45 mm, which was in normal range. There was no occlusal discrepancy. Intraoral examination revealed calculus in the lower teeth. On local examination, gingiva was soft in consistency with generalized bleeding on probing and mobility. A provisional diagnosis of chronic generalized periodontitis was given. After patient's informed consent, orthopantomograph (OPG) was taken to check for alveolar bone status. OPG revealed generalized bone loss in both maxillary and mandibular dentition. It also revealed a cleft in the right and left condylar head, suggestive of bilateral bifid condyle [Figure 1]. For confirmation, a reverse OPG was also done and it revealed the same [Figure 2]. The patient was informed about the presence of bilateral double-headed condyles.
Figure 1: Orthopantomograph revealing a cleft in the right and left condylar head, suggestive of bilateral bifid condyle

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Figure 2: Reverse orthopantomograph showing bilateral bifid condyles

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  Discussion Top


Several case reports of unilateral bifidism suggest that trauma, such as condylar fractures, birth trauma, or surgical condylectomy, can result in bifid condyles.[8]

Bilateral bifidism can result from a primary aberrancy of embryological or postnatal development. Hrdlicka[3] postulated that obstructed blood supply to the condyle during development caused division of the condyle. Blackwood[9] examined the developing condylar cartilage of the human fetus and found that it was partitioned by vascularized fibrous septa during the early phase. Persistence of these septa or rupture of blood vessels in the septa was believed to be a cause for the development of bifidity. Forman and Smith[10] presented two cases of condylar duplication in young males with no clinical signs and symptoms. There was no history of trauma in either case, and the bifid condyles were an incidental finding on radiographic examination.

Some authors have suggested that most BMCs are asymptomatic and treatment is not required for an asymptomatic BMC, even if long-term follow-up is necessary due to the possibility of delayed symptoms. However, symptomatic BMCs have also been described. Bifid formation with a temporomandibular disorder such as a clicking sound, restricted mandibular movement, pain, swelling, ankylosis, and facial asymmetry were noted in few, and thus, they are treated with nonsteroidal anti-inflammatory drugs, muscle relaxants, occlusal splints, and wooden tongue spatulas.[11]


  Conclusion Top


It can be concluded that bilateral BMCs is an extremely rare condition, although there is no epidemiological information about the actual incidence of this malformation. In this case, it is more likely to be due to some unexplained defect during the development of condylar head rather than trauma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Katti G, Najmuddin M, Fatima S, Unnithan J. Bifid mandibular condyle: Rare disease. BMJ Case Rep 2012:1-4. [doi 10.1136]. bcr-2012-007051.  Back to cited text no. 1
    
2.
Kamtane S, Subramaniam A. Bifid mandibular condyle: A very rare entity. Pak Oral Dent J 2011;31:14-6.  Back to cited text no. 2
    
3.
Hrdlicka A. Lower jaw: Double condyles. Am J Phys Anthropol 1941;28:75-89.  Back to cited text no. 3
    
4.
Szentpétery A, Kocsis G, Marcsik A. The problem of the bifid mandibular condyle. J Oral Maxillofac Surg 1990;48:1254-7.  Back to cited text no. 4
    
5.
Schier MB. The temporomandibular joint: A consideration of its probable functional and dysfunctional sequelae and report: Condyle-double in a young person. Dent Items Interest 1948;70:1095-109.  Back to cited text no. 5
    
6.
Stadnicki G. Congenital double condyle of the mandible causing temporomandibular joint ankylosis: Report of case. J Oral Surg 1971;29:208-11.  Back to cited text no. 6
    
7.
Gunduz K, Avsever H, Karacayli U. Bilateral bifid condylar process. Int J Morphol 2010;28:941-4.  Back to cited text no. 7
    
8.
Alpaslan S, Ozbek M, Hersek N, Kanli A, Avcu N, Firat M. Bilateral bifid mandibular condyle case report. Dentomaxillofac Radiol 2004;33:274-7.  Back to cited text no. 8
    
9.
Blackwood HJ. The double-headed mandibular condyle. Am J Phys Anthropol 1957;15:1-8.  Back to cited text no. 9
    
10.
Forman GH, Smith NJ. Bifid mandibular condyle. Oral Surg Oral Med Oral Pathol 1984;57:371-3.  Back to cited text no. 10
    
11.
Woo MH, Yoon KH, Park KS, Park JA. Post-traumatic bifid mandibular condyle: A case report and literature review. Imaging Sci Dent 2016;46:217-22.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]



 

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Case Report
Discussion
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