What Is Bifid Mandibular Condyle?
The bifid mandibular condyle (condyles of the lower jaw) is a rare anomaly of the temporomandibular joint that was first described by Hrdlicka in the year 1941. It is radiographically characterized by duplication of the mandibular condyle. The duplication would be attributed to a groove that occurs of variable depth in this region. Hence it's mainly categorized as one of the developmental anomalies.
The bifid mandibular condyle (BMC) comprises those features categorically of extremely rare disorders of the TMJ. The main feature of this condition is the duplication of the head of the mandibular condyle. However, the currently accepted hypothesis behind it is either linked to congenital or traumatic etiology (causes). Joint hypomobility (reduced range of motion) and arthralgia (joint pain) are the most frequently reported symptoms by the patient or observed by the dentist. It is also interesting to find rare but reported cases in medical literature and through dental research of trifid as well as tetra fid condyles in affected individuals that are due to similarly occurring grooves in multiple numbers that would cause such a condition. Treatment options for BMC often remain conservative type only.
How Does BMC Affect the Temporomandibular Joint?
The temporomandibular joint (TMJ) is the atypical and synovial type of human joint that is located between the condylar process of the mandible and the mandibular fossa as well as the articular eminence of the temporal bone of the face. The joint is divided into a superior disco-temporal space and an inferior disco-mandibular space by the meniscus of the joint.
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Bifid condyle with ankylosis can interfere with the normal functions and movements of the temporomandibular joint and its space causing a deformity of the articular fossa of the joint.
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This can lead to impairment of functions such as speech, mastication, or chewing and limitations in mouth opening.
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Patients presenting with joint or oral discomfort in bifid, trifid, or tetra fid condyles are severely compromised with functional efficiency of the jaw which can be quite debilitating. In such severe cases, treatment options such as surgery have to be considered by the maxillofacial surgeon taking into account the risk factors such as the anatomy and extent of clinical symptoms.
How Does Bifid Mandibular Condyle Occur?
The etiology and pathogenesis of BMC are not fully understood and remain currently elusive. More research is needed to investigate the reason for this developmental anomaly. Although according to dental literature, BMC is considered as a developmental abnormality as per oral pathology studies. There are multiple hypotheses suggesting of traumatic origins during the condyle formation and development to be a major reason for the anomaly.
Developmental abnormalities of the jaw would be linked to reasons such as systemic or local infections, trauma, and condylar fractures. Some authors also suggest that the mediolateral orientation of the condyle in those affected is the most common reason. It is a non-traumatic cause where the fibrous septa while its formation duplicate the condylar head. Similarly, when the condyle is oriented in an anteroposterior position, it would be definitely related to a previous traumatic experience at the region. The actual prevalence of BMC would broadly range from 0.31 % to 1.82 % globally according to research.
What Are the Symptoms and How Is BMC Diagnosed?
BMC though asymptomatic can present with very distinct clinical signs and symptoms in the patient. Patients affected by BMC may complain of:
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Pain.
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Swelling.
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Noisy joint movements.
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Hypomobility of the joint.
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Joint blocks.
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Deflection of the joint.
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Joint luxation.
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Ankylosis.
Asymptomatic cases most often are linked to a congenital origin and are mainly detected by the dentist or an oral surgeon on routine examination. However, it's the symptomatic cases that are frequently associated with traumatic events because patients may be suffering from severe discomfort, swelling, and pain because of the affected joint. BMCs are often diagnosed on panoramic radiography during a routine dental examination. However, computed tomography (CT) is considered the best choice that indicates the appropriate diagnosis of bifid condyle or the mandible. Amongst the symptomatic cases of BMC, It is not uncommon to notice that these patients may also be reporting stiffening or immobility of the joint (jaw ankylosis).
What Are Other Conditions That Resemble Bifid Mandibular Condyle?
The other conditions that resemble a bifid condyle are rheumatoid arthritis. In rheumatoid arthritis, because of TMJ involvement, similar joint symptoms such as pain, swelling, crepitation, or impairments in jaw movements are noticed. It may often be mistaken for the surface erosion of the condylar surfaces as BMC. Hence cone beam computed tomography or panoramic radiography may not prove sufficient for eliciting a final diagnosis and a detailed medical history should be taken by the dentist in arthritis patients.
What Are the Treatment Options for Bifid Mandibular Condyle?
The most common treatment options for BMC are active monitoring of the condition by the maxillofacial surgeon or dentist. Fabrication of an occlusal splint and surgical therapy of the temporomandibular joint would be indicated in 15.7 % of all cases that are affected by ankylosis (78.6 %), growth disorders (66.7 %), or hypomobility of the joint (49 %). The management options for the discomfort of oral structures in symptomatic cases of bifid mandibular condyle are listed below:
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Distinct treatment planning is done by the oral surgeon depending on the symptoms of the patient.
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Non-steroidal anti-inflammatory drugs (NSAIDs) or analgesics are commonly recommended along with oral physiotherapy.
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Occlusal splints are adjunct aids that serve as a conservative approach and as part of non-surgical therapy in BMC.
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Surgical treatment is required only when there is a need to restore function in patients suffering from both BMC along with ankylosis of the joint or even in symptomatic cases resistant to the conservative treatments mentioned above.
Conclusion:
The bifid mandibular condyle is a developmental anomaly of the temporomandibular joint that is caused due to the duplication of the mandibular condyle head. This condition can cause severe pain and discomfort to the patients and therefore requires an accurate diagnosis and correct treatment planning to restore the functional status of the TMJ and improve the quality of life.
