The double-headed mandibular condyle

doi:10.1016/0030-4220(87)90098-3

Oral Surgery, Oral Medicine, Oral Pathology

Volume 64, Issue 2, August 1987, Pages 249-251

Oral Surgery, Oral M...

https://doi.org/10.1016/0030-4220(87)90098-3 Get rights and content

Abstract

The double-headed condylar process is rare. Radiographs of four patients with this type of anomaly and one skeletal specimen are described in this article. Histologic studies in rodents suggest a possible mode of pathogenesis: maldirected muscular pull may lead to the development of an extra mandibular capitulum.

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Cited by (55)

Multi-headed (bifid and trifid) mandibular condyles in archaeological contexts: Two posttraumatic cases
2022, Archives of Oral Biology
Bifid and trifid mandibular condyles are infrequent morphological alterations of the mandibular condyle. With the aim of better identifying its possible causing factors in the past and provide clues on the potential types and severities of joint dysfunction that may occur if clinical intervention is not undertaken, two archaeological cases of multi-headed mandibular condyles are presented, and their possible aetiology and pathogenesis are discussed.
In this study, 143 adult mandibles recovered in the northwest of Spain were examined: 91 exhumed from San Juan Bautista church (Guardo, Palencia; 16th-19th centuries), and 52 from San Salvador de Palat de Rey church (León, 13th-19th centuries). All mandibles were observed macroscopically for the presence of any morphological and/or pathological alterations. When justified, the mandibles were also scrutinized through computed tomography.
Two isolated mandibles (n = 1, Palencia; n = 1, León) with multi-headed mandibular condyles (bifid and trifid) were identified. The computed tomography scan of the affected mandibles revealed alterations compatible with traumatic events, namely line fractures and deformations at the angle of the mandible.
Both the bifid and trifid mandibular condyles here described probably result from traumatic events during childhood leading to a posttraumatic deformation. Although no severe impairment of mandibular use was identified, some asymmetries probably resulted in some sort of malfunction, with TMJ-OA and gonial angle eversion as supporting evidence. Nevertheless, the degree of bone remodelling observed indicates that both individuals lived long after the traumatic occurrence.
A study on etiopathogenesis and clinical features of multi-headed (bifid and trifid) mandibular condyles and review of the literature
2018, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
MHC and BMC have been reported as rare anomalies with an uncertain cause (Almaşan et al., 2011; de Sales et al., 2004; Sahman et al., 2011a; Loh and Yeo, 1990; Woo et al., 2016). However, several factors have been put forward as possible causes of MHC, including developmental anomalies, condylar trauma, perinatal trauma, teratogenic embriopathy and condylectomy (de Sales et al., 2004; Fields and Frederiksen, 1993; Gundlach et al., 1987; Phillips and Delzer, 1992; Szentpetery et al., 1990). These factors or any other disruption of joint integrity might lead to mandibular remodeling, and thereby result in formation of a second and presumably potentially a functional new condyle.
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.
Patients were classified according to their status, etiologies, gender, functions of the mandible, interocclusal distances, pathological conditions, types, and treatment received.
BMCs were classified into two groups: type I BMCs were nontraumatic, nonsymptomatic, mediolateral, presumably developmental, and characterized by shallow grooves. Type II BMCs were traumatic and may have two subgroups. The first group of type II BMCs were mediolateral and Y-shaped. The second group of type II BMCs were characterized by two separate and anteroposteriorly located condyles.
Treatment depended on patients' complaints. In this study, asymptomatic patients did not receive therapy, whereas patients with temporomandibular join internal derangement received medical treatment, and patients with ankylosis had surgical treatment.
Bifid condyle secondary to traumatic condylar fracture
2014, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Bifid mandibular condyle (BMC) is a rare anatomical malformation characterized by a division of the mandibular condylar head. The two articulating surfaces of the bifid condyle are divided by a groove that can be oriented mediolaterally or anteroposteriorly. Reported cases in living people and in preserved specimens are mostly unilateral and, usually, asymptomatic. The etiology of BMC is not clear with a large number of postulations proposed including trauma, residual fibrous septa, infection, teratogenic substances, endocrine disorders, nutritional deficiency, infection, genetic factors and irradiation. We report a case with a bifid mandibular condyle of the left side who reported with a complaint of deviation of jaw and pain in left preauricular area. He was treated by surgical excision of the condylar heads and post surgical orthodontic treatment.
The isolated mandibular ramus - A hitherto rarely described anomaly of the mandible. Pathogenesis and treatment
2013, Journal of Cranio-Maxillofacial Surgery
A very famous paper by Sam Pruzansky, published in 1969, was entitled “Not all dwarfed mandibles are alike”. This is the topic of this paper: to describe the shape and discuss the possible pathogenesis of an extremely rare congenital dysplasia found in a unilaterally hypoplastic mandible, namely the isolated mandibular ramus.
A unique malformation of the lower jaw was found in more than 75 patients with developmental abnormalities of the mandible diagnosed and treated by the two authors in two different university hospitals over the last 40 years. We performed the following teratological experiments with laboratory rodents in order to try to understand the pathogenesis of this special dysplasia (and others): at first the normal development of the lower jaw was studied in rat and mouse foetuses. Then a variety of teratogenic drugs were applied to pregnant females and then the foetuses of these pregnancies were studied following Caesarian section.
One rat foetus was identified which presented the identical dysplasia that had been noted in the patient described here. The dam pregnant with this foetus had been given 25 mg/kg bodyweight of 6-mercaptopurine on day 12 of pregnancy. The explanation found for the pathogenesis of this anomaly was deducted from the scientific literature regarding normal development of the mandibular condyle.
The nucleus of the so-called secondary cartilage that will produce the ascending ramus (plus condyle and coronoid) is a separate growth centre which fuses a short time later with the dental bone which becomes the mandible proper by this fusion.
Bifid mandibular condyle: A disorder in its own right?
2010, Journal of the American Dental Association
Citation Excerpt :
As these examples illustrate, BMC may manifest in different morphological forms; bilobular presentation is the most common (Figure 4), although investigators also have observed triple lobular forms5,16 (Figure 5). Although the etiology of BMC is not known,10,11,13,15,23,31–34 researchers have suggested a congenital or primary cause occurring during the development of the TMJ, as well as a potential traumatic or acquired origin. Gundlach and colleagues15 conducted a study in pregnant rats and observed a BMC morphology after applying teratogenic substances.
The authors present six cases of mandibular condyle malformation. They also conducted a literature review of bifid mandibular condyle (BMC) to analyze the various hypotheses that have been made regarding the etiopathogenesis of this entity.
The authors searched the PubMed database for all instances of BMC and similar anatomical alterations, and they included non–English-language published reports. The inclusion criterion was the presence of a multilobular mandibular condyle.
Mandibular condyle may manifest in different anatomical forms; bilobular is the most common, although triple lobular morphology also has been observed. A congenital origin has been suggested as the primary cause. In addition, trauma may alter the growth of the condylar cartilage, inducing an anatomical defect. However, the majority of participants in this study had no history of trauma. The authors reviewed a total of 198 cases in study participants and cadavers.
In the absence of traumatic antecedents or other alterations of the temporomandibular joint, the presence of a BMC may be associated with developmental anomalies.
Bifid Mandibular Condyle Without History of Trauma or Pain: Report of a Case
2009, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
If trauma is eliminated from the etiology of bifid condyle differential diagnosis, then some credence should be given to 4 possible theories of developmental abnormalities. Gundlach theorizes misdirected muscle fibers shape the bifid head of the condyle.8 Blackwood and Moffet8 feel that during the development of the fetus, the partitioning of the condyle head by vascularized fibrous septa could model the condylar head into 2 separate entities.

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^∗: Nordwestdeutsche Kieferklinik.

^∗∗: Department of Dento-maxillo-facial Radiology.

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The double-headed mandibular condyle

Abstract

J Maxillofac Surg

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Aplasie und Hypoplasie des Ramus ascendens mandibulae-Klinische und experimentelle Daten

Missbildungen des Kiefergelenkes—Experimentelle und klinische Untersuchungen

Missbildungen des Kiefergelenkes bei Ratten und Mäusen

Fortschr Kiefer Gesichtschir

Formhydroxamic acid—induced malformations of the temporomandibular joint

J Maxillofac Surg

Lower jaw: double condyles

Am J Phys Anthropol

The temporomandibular joint

A consideration of its probable functional and dysfunctional sequelae and report: Condyle—double head—in a living person

Dent items interest