In the present paper we report the case of a 14-year-old girl suffering from condylar hyperplasia and enlargement of ipsilateral jaw body, stressing the importance of bone SPECT in the clinical management of this temporomandibular joint (TMJ) disorder. Condylar hyperplasia is an uncommon idiopathic monolateral disorder of jaw growth consistent with exuberant or persistent activity of the condyle nucleus finally involving sociopsychological aspects due to facial dysmorphism. Besides facial asymmetry our patient showed prognathism, malocclusion, worsening otalgia and headache. Conventional X-rays examinations and multislice spiral CT gave us important morphostructural information also thanks to 3D volume-rendered and virtual reconstructions, while bone SPECT by detecting an intense well focused (99m)Tc-MDP uptake allowed to achieve uninvasively the final diagnosis of primary condyle hyperplasia. In spite of the full imaging characterization of TMJ disorders, consensus on best timing and therapeutic approaches on condylar hyperplasia is yet to be reached. In the present case patient was first treated orthodontically, planning a "high" condylectomy intervention after at least 6 months.