Clinical Oral Investigations

, Volume 18, Issue 4, pp 1237–1244 | Cite as

Incidental findings on cone beam computed tomography scans in cleft lip and palate patients

  • Mette A. R. KuijpersEmail author
  • Andrzej Pazera
  • Ronald J. Admiraal
  • Stefaan J. Bergé
  • Arjan Vissink
  • Pawel Pazera
Original Article



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.

Subjects and 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.


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.


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.

Clinical relevance

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.


Cone beam computed tomography Diagnostic imaging Cleft palate Incidental findings 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Allareddy V, Vincent SD, Hellstein JW, Qian F, Smoker WR, Ruprecht A (2012) Incidental findings on cone beam computed tomography images. Int J Dent 2012:871532. doi: 10.1155/2012/871532, Epub 2012 Dec 10PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Rege IC, Sousa TO, Leles CR, Mendonça EF (2012) Occurrence of maxillary sinus abnormalities detected by cone beam CT in asymptomatic patients. BMC Oral Health 10:12–30Google Scholar
  3. 3.
    Price JB, Thaw KL, Tyndall DA, Ludlow JB, Padilla RJ (2012) Incidental findings from cone beam computed tomography of the maxillofacial region: a descriptive retrospective study. Clin Oral Implants Res 23:1261–1268PubMedCrossRefGoogle Scholar
  4. 4.
    Plooij JM, Maal TJ, Haers P, Borstlap WA, Kuijpers-Jagtman AM, Bergé SJ (2011) Digital three-dimensional image fusion processes for planning and evaluating orthodontics and orthognathic surgery. A systematic review. Int J Oral Maxillofac Surg 40:341–352PubMedCrossRefGoogle Scholar
  5. 5.
    Timmerman K, Vander Poorten V, Desloovere C, Debruyne F (2006) The middle ear in cleft palate patients in their early teens: a literature study and preliminary file study. B-ENT 2(Suppl 4):95–101Google Scholar
  6. 6.
    Sheahan P, Miller I, Sheahan JN, Earley MJ, Blayney AW (2003) Incidence and outcome of middle ear disease in cleft lip and/or cleft palate. Int J Pediatr Otorhinolaryngol 67:785–793PubMedCrossRefGoogle Scholar
  7. 7.
    Flynn T, Lohmander A, Moller C, Magnusson L (2013) A longitudinal study of hearing and middle ear status in adolescents with cleft lip and palate. Laryngoscope 23:1374–1380CrossRefGoogle Scholar
  8. 8.
    Hocevar-Boltezar I, Jarc A, Kozelj V (2006) Ear, nose and voice problems in children with orofacial clefts. J Laryngol Otol 120:276–281PubMedCrossRefGoogle Scholar
  9. 9.
    Polder BJ, Van ‘t Hof MA, Van der Linden FP, Kuijpers-Jagtman AM (2004) A meta-analysis of the prevalence of dental agenesis of permanent teeth. Commun Dent Oral Epidemiol 32:217–226CrossRefGoogle Scholar
  10. 10.
    Tannure PN, Oliveira CA, Maia LC, Vieira AR, Granjeiro JM, de Castro CM (2012) Prevalence of dental anomalies in nonsyndromic individuals with cleft lip and palate: a systematic review and meta-analysis. Cleft Palate Craniofac J 49:194–200PubMedCrossRefGoogle Scholar
  11. 11.
    Tortora C, Meazzini MC, Garattini G, Brusati R (2008) Prevalence of abnormalities in dental structure, position, and eruption pattern in a population of unilateral and bilateral cleft lip and palate patients. Cleft Palate Craniofac J 45:154–162PubMedCrossRefGoogle Scholar
  12. 12.
    Pette GA, Norkin FJ, Ganeles J, Hardigan P, Lask E, Zfaz S, Parker W (2012) Incidental findings from a retrospective study of 318 cone beam computed tomography consultation reports. Int J Oral Maxillofac Implants 27:595–603PubMedGoogle Scholar
  13. 13.
    Pazera P, Bornstein MM, Pazera A, Sendi P, Katsaros C (2011) Incidental maxillary sinus findings in orthodontic patients: a radiographic analysis using cone-beam computed tomography (CBCT). Orthod Craniofacial Res 14:17–24CrossRefGoogle Scholar
  14. 14.
    Cha JY, Mah J, Sinclair P (2007) Incidental findings in the maxillofacial area with 3-dimensional cone-beam imaging. Am J Orthod Dentofac Orthop 132:7–14CrossRefGoogle Scholar
  15. 15.
    Cağlayan F, Tozoğlu U (2012) Incidental findings in the maxillofacial region detected by cone beam CT. Diagn Interv Radiol 18:159–163PubMedGoogle Scholar
  16. 16.
    Gracco A, Incerti Parenti S, Ioele C, Alessandri Bonetti G, Stellini E (2012) Prevalence of incidental maxillary sinus findings in Italian orthodontic patients: a retrospective cone-beam computed tomography study. Korean J Orthod 42:329–334PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Ritter L, Lutz J, Neugebauer J, Scheer M, Dreiseidler T, Zinser MJ, Rothamel D, Mischkowski RA (2011) Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111:634–640PubMedCrossRefGoogle Scholar
  18. 18.
    Carter L, Farman AG, Geist J, Scarfe WC, Angelopoulos C, Nair MK, Hildebolt CF, Tyndall D, Shrout (2008) American Academy of Oral and Maxillofacial Radiology executive opinion statement on performing and interpreting diagnostic cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:561–562PubMedCrossRefGoogle Scholar
  19. 19.
    Horner K, Islam M, Flygare L, Tsiklakis K, Whaites E (2009) Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 38:187–195PubMedCrossRefGoogle Scholar
  20. 20.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  21. 21.
    Miyamoto J, Nagasao T, Nakajima T, Ogata H (2007) Evaluation of cleft lip bony depression of piriform margin and nasal deformity with cone beam computed tomography: “retruded-like” appearance and anteroposterior position of the alar base”. Plast Reconstr Surg 120:1612–1620PubMedCrossRefGoogle Scholar
  22. 22.
    Miyamoto J, Nakajima T (2010) Anthropometric evaluation of complete unilateral cleft lip nose with cone beam CT in early childhood. J Plast Reconstr Aesthet Surg 63:9–14PubMedCrossRefGoogle Scholar
  23. 23.
    Nagasao T, Miyamoto J, Hikosaka M, Yoshikawa K, Ishii N, Nakajima T (2008) A new method to quantify subtle morphological deformities in nasal profile curvatures and its application for analysis of unilateral cleft lip noses. J Craniomaxillofac Surg 36:321–334PubMedCrossRefGoogle Scholar
  24. 24.
    Oberoi S, Gill P, Chigurupati R, Hoffman WY, Hatcher DC, Vargervik K (2010) Three-dimensional assessment of the eruption path of the canine in individuals with bone-grafted alveolar clefts using cone beam computed tomography. Cleft Palate Craniofac J 47:507–512PubMedCrossRefGoogle Scholar
  25. 25.
    Garib DG, Yatabe MS, Ozawa TO, Da Silva Filho OG (2012) Alveolar bone morphology in patients with bilateral complete cleft lip and palate in the mixed dentition: cone beam computed tomography evaluation.”. Cleft Palate Craniofac J 49:208–214PubMedCrossRefGoogle Scholar
  26. 26.
    Li F, Wang JG (2011) Measurement of tooth length of upper canines in complete unilateral cleft lip and palate patients with cone-beam computed tomography. Hua Xi Kou Qiang Yi Xue Za Zhi 29(161–163):167Google Scholar
  27. 27.
    Padricelli G, Monsurro A, Grassia V, Perillo L (2012) The frequency of dental anomalies in subjects with cleft lip and palate. Mondo Ortodontico 37:46–55CrossRefGoogle Scholar
  28. 28.
    Cheung T, Oberoi S (2012) Three dimensional assessment of the pharyngeal airway in individuals with non-syndromic cleft lip and palate. PLoS ONE 7:e43405PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Yoshihara M, Terajima M, Yanagita N, Hyakutake H, Kanomi R, Kitahara T, Takahashi I (2012) Three-dimensional analysis of the pharyngeal airway morphology in growing Japanese girls with and without cleft lip and palate. Am J Orthod Dentofac Orthop 141:S92–S101CrossRefGoogle Scholar
  30. 30.
    Zhou W, Li W, Lin J, Liu D, Xie X, Zhang Z (2012) Tooth lengths of the permanent upper incisors in patients with cleft lip and palate determined with cone beam computed tomography. Cleft Palate Craniofac J 50:88–95PubMedCrossRefGoogle Scholar
  31. 31.
    Stefanini R, Tufik S, Soares MC, Haddad FL, Bittencourt LR, Santos-Silva R, Gregorio LC (2012) Systematic evaluation of the upper airway in the adult population of São Paulo, Brazil. Otolaryngol Head Neck Surg 146:757–763PubMedCrossRefGoogle Scholar
  32. 32.
    Yiğit O, Acioğlu E, Cakir ZA, Sişman AS, Barut AY (2010) Concha bullosa and septal deviation. Eur Arch Otorhinolaryngol 267:1397–1401PubMedCrossRefGoogle Scholar
  33. 33.
    Reitzen SD, Chung W, Shah AR (2011) Nasal septal deviation in the pediatric and adult populations. Ear Nose Throat J 90:112–115PubMedGoogle Scholar
  34. 34.
    Dik EA, de Ruiter AP, van der Bilt A, Koole R (2010) Effect on the contour of bone and soft tissue one year after harvesting chin bone for alveolar cleft repair. Int J Oral Maxillofac Surg 39:962–967PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Mette A. R. Kuijpers
    • 1
    • 2
    Email author
  • Andrzej Pazera
    • 3
  • Ronald J. Admiraal
    • 2
    • 4
  • Stefaan J. Bergé
    • 2
    • 5
  • Arjan Vissink
    • 6
  • Pawel Pazera
    • 7
  1. 1.Department of Orthodontics and Craniofacial BiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.Cleft Palate Craniofacial UnitRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  3. 3.Department of RadiologyHospital of NeuchâtelLa Chaux-de-FondsSwitzerland
  4. 4.Department of OtorhinolaryngologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  5. 5.Department of Maxillofacial SurgeryRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  6. 6.Department of Maxillofacial SurgeryUniversity Medical Centre GroningenGroningenThe Netherlands
  7. 7.Department of Orthodontics and Dentofacial OrthopaedicsUniversity of BernBernSwitzerland

Personalised recommendations