Morphological and Structural Analysis of the Bifid Mandibular Condyle Using Cone Beam Computed Tomography. A Case Report

The bifid mandibular condyle is an uncommon morphological anomaly characterized by division of the condylar head into two articular surfaces. Commonly considered a radiological finding, its etiology may be congenital, traumatic, genetic, or environmental. Its orientation is usually classified as mediolateral or anteroposterior. BMC is generally asymptomatic, although it may also present with arthralgia, joint sounds, and functional limitation of the temporomandibular joint (TMJ). In the present case, evaluation by digital orthopantomography (OPT) revealed the initial suspicion of a unilateral right BMC. Cone-beam computed tomography (CBCT) confirmed the diagnosis and enabled a thorough three-dimensional analysis. Using specific TMJ software tools and pseudocolor algorithms, it was possible to determine not only the morphology but also the degree of mineralization of the BMC, detecting low-density trabecular bone (85 HU) and a thin cortical layer with loss of continuity. Although the prevalence of BMC is not well known, in recent years, thanks to high-resolution procedures such as CBCT, its prevalence appears to be higher than previously reported, reaching up to 5.8%. This advanced imaging algorithm is consolidated as the “gold standard” for the diagnosis and analysis of BMC, overcoming the limitations of conventional radiology by providing detailed information in the three spatial planes and 3D reconstructions with low radiation exposure for the patient, following the ALADAIP principle: as low as diagnostically acceptable, indication-oriented, and patient-specific. In conclusion, in some patients with a diagnosis or suspicion of bifid mandibular condyle, clinical and radiological examination should be complemented by specific high-complexity imaging methods that provide high-resolution images, allowing a thorough and complete analysis of each anatomical detail for a more precise assessment of the bifid mandibular condyle.