title: Incidental findings on cone beam computed tomography scans in cleft lip and palate patients.
abstract: OBJECTIVE
  Cone beam computed tomography (CBCT) is frequently used in treatment planning for alveolar bone grafting (ABG) and orthognathic surgery in patients with cleft lip and palate (CLP). CBCT images may depict coincident findings. The aim of this study was to assess the prevalence of incidental findings on CBCT scans in CLP patients.
  
  
  METHODS
  Initial CBCTs taken from consecutive patients (n = 187; mean age 11.7 years, range 6.9-45) with a non-syndromic orofacial cleft from January 2006 until June 2012 were systematically evaluated. Twenty-eight patients (mean age 19.3 years, range 13.2-30.9) had been subjected to ABG before their first CBCT was taken; 61 patients had a CBCT before and after ABG. Sinuses, nasopharynx, oropharynx, throat, skull, vertebrae, temporomandibular joint (TMJ), maxilla and mandible were checked for incidental findings.
  
  
  RESULTS
  On 95.1 % of the CBCTs, incidental findings were found. The most prevalent were airway/sinus findings (56.1 %), followed by dental problems, e.g. missing teeth (52 %), nasal septum deviation (34 %), middle ear and mastoid opacification, suggestive for otitis media (10 %) and (chronic) mastoiditis (9 %), abnormal TMJ anatomy (4.9 %) and abnormal vertebral anatomy (1.6 %). In the 28 patients whose first CBCT was taken at least 2 years after ABG, bone was still present in the reconstructed cleft area except in 2 out of 12 patients with a bilateral CLP. The ABG donor site (all bone grafts were taken from the chin area) was still recognizable in over 50 % of the patients. Based on the CBCT findings, 10 % of the patients were referred for further diagnosis and 9 % for further treatment related to dental problems.
  
  
  CONCLUSIONS
  Incidental findings are common on CBCTs. Compared with the literature, CLP patients have more dental, nasal and ear problems. Thus, whenever a CBCT is available, this scan should be reviewed by all specialists in the CLP team focusing on their specific background knowledge concerning symptoms and treatment of these patients.
  
  
  CONCLUSIONS
  The high number of findings indicates that CBCT imaging is a helpful tool in the treatment of CLP patients not only related to alveolar bone grafting and orthognathic surgery but it also provides diagnostic information for almost all specialties involved in CLP treatment.
authors: Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. m.kuijpers@dent.umcn.nl.|Cleft Palate Craniofacial Unit, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. m.kuijpers@dent.umcn.nl.
authors: Mette A R
authors: MAR
authors: Kuijpers
authors: Department of Radiology, Hospital of Neuchâtel, 2300, La Chaux-de-Fonds, Switzerland.
authors: Andrzej
authors: A
authors: Pazera
authors: Cleft Palate Craniofacial Unit, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.|Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, 377 KNO, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors: Ronald J
authors: RJ
authors: Admiraal
authors: Cleft Palate Craniofacial Unit, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.|Department of Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, 590 MKA, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors: Stefaan J
authors: SJ
authors: Bergé
authors: Department of Maxillofacial Surgery, University Medical Centre Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
authors: Arjan
authors: A
authors: Vissink
authors: Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
authors: Pawel
authors: P
authors: Pazera
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002971:Cleft Lip / Q000000981:diagnostic imaging*; D002972:Cleft Palate / Q000000981:diagnostic imaging*; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D055815:Young Adult
references: Cleft Palate Craniofac J. 2013 Jan;50(1):88-95
references: 22428573
references: J Craniomaxillofac Surg. 2008 Sep;36(6):321-34
references: 18430579
references: Plast Reconstr Surg. 2007 Nov;120(6):1612-1620
references: 18040196
references: Int J Oral Maxillofac Surg. 2010 Oct;39(10):962-7
references: 20615664
references: Ear Nose Throat J. 2011 Mar;90(3):112-5
references: 21412740
references: Cleft Palate Craniofac J. 2012 Mar;49(2):208-14
references: 21740185
references: Int J Oral Maxillofac Surg. 2011 Apr;40(4):341-52
references: 21095103
references: BMC Oral Health. 2012 Aug 10;12:30
references: 22883529
references: Hua Xi Kou Qiang Yi Xue Za Zhi. 2011 Apr;29(2):161-3, 167
references: 21598488
references: Clin Oral Implants Res. 2012 Nov;23(11):1261-8
references: 22092929
references: Community Dent Oral Epidemiol. 2004 Jun;32(3):217-26
references: 15151692
references: Orthod Craniofac Res. 2011 Feb;14(1):17-24
references: 21205165
references: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Oct;106(4):561-2
references: 18928899
references: Diagn Interv Radiol. 2012 Mar-Apr;18(2):159-63
references: 21960135
references: Laryngoscope. 2013 Jun;123(6):1374-80
references: 23208794
references: Am J Orthod Dentofacial Orthop. 2007 Jul;132(1):7-14
references: 17628245
references: Korean J Orthod. 2012 Dec;42(6):329-34
references: 23323247
references: Int J Oral Maxillofac Implants. 2012 May-Jun;27(3):595-603
references: 22616053
references: J Plast Reconstr Aesthet Surg. 2010 Jan;63(1):9-14
references: 19058773
references: Cleft Palate Craniofac J. 2010 Sep;47(5):507-12
references: 20184425
references: Int J Dent. 2012;2012:871532
references: 23304148
references: Eur Arch Otorhinolaryngol. 2010 Sep;267(9):1397-401
references: 20306067
references: Am J Orthod Dentofacial Orthop. 2012 Apr;141(4 Suppl):S92-101
references: 22449605
references: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 May;111(5):634-40
references: 21444226
references: J Laryngol Otol. 2006 Apr;120(4):276-81
references: 16623971
references: Dentomaxillofac Radiol. 2009 May;38(4):187-95
references: 19372107
references: Int J Pediatr Otorhinolaryngol. 2003 Jul;67(7):785-93
references: 12791455
references: B-ENT. 2006;2 Suppl 4:95-101
references: 17366853
references: Cleft Palate Craniofac J. 2008 Mar;45(2):154-62
references: 18333651
references: Cleft Palate Craniofac J. 2012 Mar;49(2):194-200
references: 21740173
references: Biometrics. 1977 Mar;33(1):159-74
references: 843571
references: Otolaryngol Head Neck Surg. 2012 May;146(5):757-63
references: 22298684
references: PLoS One. 2012;7(8):e43405
references: 22952677