Mandibular condylar hyperplasia (CH) is a complex developmental deformity resulting in asymmetries of the hyperplastic condyle. Bone scan SPECT is a sensitive and accurate method of detecting the growth activity of this disorder. This method can be used to quantitate the radionuclide uptake differences between the left and right condyles. Uptake differences of 10% or more between the left and right condyles, with increased uptake ipsilateral to the CH, are considered to be evidence of active growing CH. Quantitative assessment of CH is important to select an appropriate treatment course. Degenerative arthropathies of the temporomandibular joints may result in altered uptake, but this is mostly associated with the side contralateral to the CH. The CT portion of SPECT/CT is useful to assess the condylar dimensions and underlying bony changes.