Severely Limited Airway and Likely Dual Bite Identified on General Review

A 37-year-old male was referred by a general dentist for a general review, with no airway or TMJ focus. During full-volume review, the radiologist identified a severely limited airway, with a minimum cross-sectional area of 35.9 square millimeters in the oropharyngeal region. The condyles were positioned inferiorly and anteriorly with the patient in maximum intercuspation, and the TMJs showed functional remodeling. The radiographic findings favored a dual bite, a condition in which condylar position and occlusion change as a postural compensation for a small airway.

The radiologist noted that a dual bite is an orthopedically unstable position for the condyles, and that any restorative or prosthetic work or use of an occlusal appliance could allow the condyles to seat further into the fossae, facilitating an occlusal change that would be difficult for the clinician to manage and potentially significant for the patient. The radiologist highlighted the case as a demonstration of the wider maxillofacial consequences of a compromised airway and, because the findings were incidental, of the importance of full-volume review.