ANATOMICAL VARIATION OF MANDIBULAR CONDYLE - A
DIGITAL RADIOGRAPHY STUDY IN WESTERN MAHARASHTRA
1
*Dr. K.A. Kamala, 2Dr. S. Sankethguddad, 3Dr. Ashwini Rani SR. and 4Dr. Abhijeeth
R. Sande
1
M.D.S., Associate Professor, Department of Oral Medicine And Radiology, School of
Dental Sciences, KIMSDU, Karad, Pin Code -415110, District- Satara, Maharashtra, India.
2M.D.S. Department of Periodontology, Shivtej Arogya Seva Sanstha’s Yogita Dental
College and Hospital, Khed, District- Ratnagiri, Maharashtra, India.
3,4
M.D.S., Senior Lecturer, Department of Oral Medicine and Radiology, School of Dental
Sciences, KIMSDU, Karad, Pin Code -415110, District- Satara, Maharashtra, India.
The appearance of the mandibular condyle varies greatly among
different age groups and individuals.[1] Osteology states that
morphologic alterations occur on the basis of simple developmental
variability as well as remodeling of condyle to accommodate
developmental variations, endocrine disturbances, radiation therapy,
malocclusion, trauma and other developmental abnormalities and
diseases.[2] The mandibular condyle varies considerably both in size and shape. When viewed from above, i.e., the bird’s eye view condyle
appears roughly ovoid in outline. It is 15-20 mm mediolaterally and
8-10 mm postero-anteriorly. There is great variation in the size and shape
of the components of the tempero-mandibular joint (TMJ), and its
relationship to each other.[3]
It is often assumed that the normal condylar head must have a convex
configuration throughout and that symmetry should exist between contralateral sides in the
same individual. Several studies have attempted to evaluate the morphology of the human
condyle. Variation in the human mandibular condyle shapes was noted by previous
researchers. A normal variation of the condylar morphology occurs with age, gender, facial
type, occlusal force, functional load, malocclusion type and between right and left sides.[4]
Volume 8, Issue 9, 767-774. Research Article ISSN 2277– 7105
Article Received on 30 May 2019,
Revised on 20 June 2019, Accepted on 10 July 2019
DOI: 10.20959/wjpr20199-15360
*Corresponding Author
Dr. K. A. Kamala
M.D.S., Associate professor,
Department of Oral
Medicine And Radiology,
School of Dental Sciences,
KIMSDU, Karad, Pin code
-415110, District- Satara,
Maxillofacial radiography by means of orthopantamogram (OPG) is used as a routine
screening tool in diagnosis and treatment planning in various fields of dentistry, and is found
to be less expensive when compared to other advanced imaging modalities like CT, MRI and
CBCT.[5] In a panoramic image, different shapes of the coronoid process, condyle and
sigmoid notch can be often appreciated.[6] It also yields a favorable cost-benefit relationship
and exposes patients to relatively low doses of radiation.[7,8] However, due to lack of
epidemiological data, there is not enough information to determine the true frequency and
characteristics of this morphological variation of condyle. The human condyle has a capacity
for remodeling which are influenced by a variety of factors which can result in morphological
diversity and variations in shape. Several studies have dealt with the position of the condyle
but not much emphasis has been laid on the shape of the condyle.[9,10] The present study is
aimed at observing and recording the variation in the shapes of condyle on an OPG and
thereby evaluate whether the determination of the shapes could aid in diagnostics.
METHODOLOGY
The present study was conducted in the Department of Oral Medicine and Radiology. A total
of 1460 digital OPGs obtained from November 2017 to May 2019, of patients over 20 years
of age, which were available as soft copies in the archival records of our Radiology
Department were selected for the study.
The Institutional Ethical Committee approval was obtained before commencement of the
study. Digital Ortho-pantamographs (OPG) were obtained from Carestream Digital Health
INC- France, Model- CS-8100SC using charged coupled device sensors under standard exposure factors (KVp of 90, duration of 13s, and current of 9 mA). Digital OPG’s free of
any projection errors, which showed Condylar head clearly and accurately with optimal
density and contrast were selected for the study. Radiographs with positioning and
magnification errors were excluded during the evaluation process. All OPGs were made and
evaluated in the same manner by two oral radiologists for the formulation of operational
definitions. Condylar morphology of four types were recorded according to the classification
done by Chaudhry et al.[11] namely: Type I - Oval shape, Type II - Diamond shape, Type III -
Bird beak shape, Type IV - Crooked finger shape. Apart from this, some OPGs showed
combination of above mentioned shapes which was added in above classification.
generated using Statistical Package for Social Sciences Version 20 (SPSS version 20, IBM,
Armonk, NY, United states of America).
RESULTS
The following shapes were perceived among the western Maharashtra population namely, (i)
Oval, (ii) bird beak, (iii) diamond, and (iv) crooked finger in 1460 OPGs. The most common
shape was found to be oval 786 (53.83%), followed by bird beak 195 (13.35%), diamond 98
(6.71%), and crooked finger 43 (2.98%). The combination of the above shapes was seen in
338 (23.15%) radiographs [Table 1].
Out of 1460 radiographs 857 (58.69%) belongs to males and 603 (41.30) belongs to females
with male predominance. The most common shape observed among both the males and
females was the oval where the former was accounted for 447 (52%) while the latter 339
(56.21%) followed by bird beak, diamond and croocked finger in both males and females. In
males bird beak was seen in 116 (13.53) followed by diamond 57 (6.65%) and croocked
finger 26 (3.03%). In females bird beak was seen in 79 (13.10%) followed by diamond 41
(6.79) and crookec finger 17 (2.81%). Out of 857 male patients radiographs combinations of
the shapes was seen in 211 (24.62%) and out of 603 females patients radiographs 127
(21.06%) combinations shapes were seen [Table 2].
Of the 1460 OPGs 338 (23.15%) showed various combinations of condyles. The shapes
predominant in both genders were determined. Of 338 OPGs which showed combinations of
shapes 211 (62.42%) belongs to males patients and 127 (37.57%) belongs to female patients.
Oval/oval combination was most prevalent in both male 86 940.75%) and female 63
(49.49%) OPGs, followed by oval/bird beak, oval/diamond, bird beak/bird beak and croocked
finger/croocked finger [Table 3].
Table 1: Different shapes of Mandibular condyles.
Shapes of condyles Numbers (%) Percentage (%)
Table 2: The shapes commonly occurring in both genders.
Shapes commonly seen Male (%) Female (%) Total
Oval 447 (52.15) 339 (56.21) 786 Bird beak 116 (13.53) 79 (13.10) 195 Diamond 57 (6.65) 41 (6.79) 98 Croocked finger 26 (3.03) 17 (2.81) 43 Combination of above 211 (24.62) 127 (21.06) 338 Total (%) 857 (100) 603 (100) 1460
Table 3: Occurrence of combination of shapes of Mandibular condyles.
Combination of condylar shapes Male (%) Female (%)
Oval/ Oval 86 (40.75%) 63 (49.60%) Oval/Bird beak 45 (21.32%) 31 (24.40%) Oval/Diamond 38 (18) 20 (15.74%) Bird beak/ Bird beak 24 (11.37%) 8 (6.29%) Croocked finger/ Croocked finger 18 (8.53) 5 (3.93%) Total 211 (100) 127 (100)
DISCUSSION
The appearance of the mandibular condyle varies greatly among different age groups and
individuals. Morphologic changes may occur on the basis of simple developmental variability
as well as remodeling of condyle to accommodate developmental variations, malocclusion,
trauma and other developmental abnormalities and diseases.[12]
Condylar shape classification has been elaborated and argued for decades by means of
antero-posterior, superior and lateral view radiograph.[13] Several authors have discussed
about various types of condyle without giving proper classification.[14]
In 1960s and 1970s studies were performed mainly on dry skulls and autopsy materials.[15-17]
These studies used macroscopic observations, radiological cephalometry and tomography. In
1961, Yale et al.[15] was the first one to report about the different shapes of mandibular
condyle. Initially Yale classified condylar head based on superior view into three categories
namely concave, convex and flat, however later on he simplified it into four categories
namely convex, flattened, angled and rounded.[15,16,18]
A study in 1980’s on mandibular condyle morphology in relation to malocclusion in children
revealed that the condylar size in males was greater than in females and midline discrepancy
Evaluation of shape of the condyles upon surgical exposure of TMJ revealed that most
condyles had a normal size and shape. Other varieties like excavated form, oblique shape,
small round condyles and flattened condyles were also noted.[20]
Radiographic analysis showed that in the anterior view, 58.4% of the specimens exhibited a
plane or slightly convex shape, 25% a well-rounded or convex shape, 16.6% were shaped like
an inverted "V", and only 3.1% were convex. In the upper view, many of the condyles (60%)
had an oblong shape, 20% were pear-shaped and laterally tapered, 18.4% were pear-shaped
but medially tapered, and only 1.6% had a rounded or oval shape. Of the skulls examined in
the lateral view, 55% were pointy or shaped like an inverted "V", 31.7% had a convex shape,
and 13.3% were plane or slightly convex.[21]
By using high resolution CT images condyle morphology was classified as flat, round,
convex, concave and angled. Convex type was observed very frequently followed by angled,
concave and round. In women convex type was observed predominantly, whereas in men
concave type.[22]
Using different radiographic techniques many studies were done to detect the condylar
morphology, to compare the accuracy of detecting condylar changes in TMJ disorders.
Previous studies regarding the morphology of condyle have shown that shape variability of
the condyle was mainly related to inclination of the condylar head, shape variability of the
fossa was related to inclination of the eminence and fossa height.[23]
A study conducted by Oliveira et al.[24] to assess the condyle morphology on OPG of
asymptomatic TMJ patient, had shown the round shape to be more frequent followed by
pointed and flat shapes, which was similar finding among females in the present study.
The studies reported by Ribeiro et al.[25] and Choudhary et al.[11] pertaining to the Brazilian
and East Indian population respectively had shown that round/oval shape to be common in
both the sexes which goes in accordance with our study but with correspondence to the
females of our ethnic group.
Singh and Chakrabarty.[13] conducted study to determine and classify the shape of condyle
on OPG. The sample included 100-OPG from14 to 45 years old, 52 males and 48 females.
Round type of condyle is more frequent than other varieties and not associated with any sex
predilection.
Sahithi et al.[5] conducted study on 200 digital OPGs comprising of both the sexes and the
different shapes of the coronoid process, condyle and the sigmoid notch were traced on
projection sheets for both the right and left sides. Study has illustrated various morphological
shapes of condyle. The most commonly observed cobdylar shape among the males and
females were angled and round shapes respectively. These variations when compared on both
the sides had shown no statistical significance.
Sonal et al.[3] conducted study in 200 digital OPGs taken for routine investigation to evaluate
condylar morphology. Of the 200 pairs of condylar heads evaluated, 60% were oval in shape,
followed by bird beak (29%), diamond (9%) and least being crooked finger (2%). Oval-oval
was commonly occurring combination (67%), whereas crooked/ crooked finger was a rarity.
Our study had showed the most common shape observed among both the males and females
was the oval and least was crooked finger. Oval/oval combination was most prevalent in both
male and female and least was croocked finger/croocked finger. The results of the present
study were similar to those of Sonal et al.[3] and Chaudhary et al.[11]
CONCLUSION
The present study is an attempt to scout the prevalent radiographic shapes of the condylar
head on the OPG. Low exposure dose and ease of prescription makes OPG a common choice
of imaging prescription. Evaluation of condyle on OPG seems to attract clinicians to make
fine observations. Oval-oval being most common in both genders. More sample size and
evaluation of other parameters may aid in giving more information. Within its limitations,
confining to our population, the present study had witnessed various morphological shapes of
condyle using the panoramic radiographs as a probable approach for personal identification.
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