Bifid mandibular condyle: archaeological case report of a rare anomaly

Multi-headed (bifid and trifid) mandibular condyles in archaeological contexts: Two posttraumatic cases

OBJECTIVE

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.

DESIGN

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.

RESULTS

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.

CONCLUSIONS

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.

Magnetic resonance imaging findings of true bifid mandibular condyle with duplicated mandibular fossa

Bifid mandibular condyle (BMC) is a rare asymptomatic morphological alteration with no predilection for age group or gender. Its morphology varies from a shallow groove to two condylar heads with separate necks, oriented mediolaterally or anteroposteriorly. This report describes an unusual case of anteroposterior bifid condyle in a 39-year-old female patient with the main complaint of mouth-opening limitation and a deviation of the mandible to the left side. Magnetic resonance imaging (MRI) findings revealed a bifid condyle on the left side and duplicated mandibular fossa, with the articular disc over the anterior head. The MRI images in the open-mouth position revealed minimal movement of the condyle. Despite the increased number of mediolateral bifid mandibular condyle cases described in the literature, none of previously reported cases of BMC included an anteroposterior bifid condyle case with two distinct mandibular fossa.

Europe's oldest jaw: evidence of oral pathology

Atapuerca, in the north of Spain, is the archaeological site where the oldest hominid remains within Europe have been found. In 2008 a jaw fragment, corresponding to the symphyseal area, was discovered in the area called the 'Elephant's pit'. Its age has been estimated at 1.2 million years and it is considered to be the oldest human fossil found in Europe and is from the lower Pleistocene. This work analyses the dental and skeletal damage to the specimen, detected in a macroscopic study of possible horizontal and vertical bone loss at the level of support of the remaining teeth. The limited presence of dental scale, the pattern of destruction and the decreased bone density due to increased marrow spaces suggest the presence of possible periodontal disease.

Unilateral trifid mandibular condyle: a case report

Trifid mandibular condyle is an exceptionally rare entity, diagnosed accidentally on radiographic examination. Its etiology is controversial. Dental professionals should have knowledge of this anatomic abnormality and of the problems caused by it in normal function, as well as appropriate treatment modalities. In the literature, only three such cases have been reported. The current case report (the fourth reported) is of a unilateral trifid condyle reported in a 37-year-old woman seeking treatment for a missing tooth. A panoramic radiograph accidentally revealed a discrete modification of the right mandibular condyle. Computed tomography (CT) with 3-D construction was done to confirm the diagnosis.

Bifid mandibular condyle: a disorder in its own right?

BACKGROUND

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. Type of Studies Reviewed. 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.

RESULTS

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.

CLINICAL IMPLICATIONS

In the absence of traumatic antecedents or other alterations of the temporomandibular joint, the presence of a BMC may be associated with developmental anomalies.

The false and the true bifid condyles

The bifid mandibular condyle has been described as a condition of unknown aetiology and uncertain pathogenesis. Many see it as the product of accidental trauma or forceps delivery, with the two heads occurring one behind the other in the sagittal plane. In bioanthropological literature, "bifid condyle" often describes pitting in the sagittal plane, dividing the condyle mediolaterally. We examined 38 male and 16 female pre-European-contact Pacific islanders' adult mandibles, and 24 male and 29 female modern Indian mandibles, recording frequency, prominence and position of any condylar groove in both coronal and sagittal planes. We report the tenth known case of a bilaterally-bifid condyle. A groove was found almost twice as likely to occur on the left condyle of the Indians than of the Pacific Islanders, but equally likely to occur on the right side of both groups. That same finding applied to males and females. In order to avoid terminological ambiguity, we suggest that the term "bifid condyle" should be reserved for describing multiple condyles in the sagittal plane only - the true bifid condyle. An hypothesis is offered for the occurrence of the groove in the sagittal plane.

Computed tomography imaging findings of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis: case report

Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings.

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.

Probable keratocyst in a mandible from the late Roman era

Odontogenic keratocysts, characterized by considerable local aggressiveness and high recurrence rates, account for 5-15% of all odontogenic cysts. This paper reviews the literature and describes the most important aspects of this type of cyst, a clinical example being given as way of illustration. We also report a paleopathological case featuring an osteolytic lesion where the characteristics are consistent with a keratocyst. The aim is thus to encourage odontologists to contribute to research in the field of paleopathology.