# Incidental Findings in Patients with Cleft Lip and Palate: A Case-Control Study
## 4 Discussion
These findings agree with other reports that concluded that tooth agenesis occurs mainly at the cleft side, and the most prevalent missing tooth is the lateral incisor [27; 28; 29; 41; 42; 43]. A cross-sectional study [44] estimated the prevalence of tooth agenesis in a large sample of 5005 non-cleft individuals at 7.1%, which is comparable to the reports of [PERSON] [45] (0.15-16.2%, excluding the third molars). We also observed a considerably lower rate of tooth agenesis in the non-cleft group than in the cleft group. The existing body of evidence is ambiguous regarding the association of tooth agenesis with gender. Some studies reported no differences in the distribution of developmental dental abnormalities between male and female patients [41; 46], while others suggested a gender-related tendency in the agenesis of maxillary lateral incisors and maxillary second premolars [27]. The lack of variability in the dependent variable in our study rendered the investigation of a potential association between tooth agenesis and gender impossible. The literature highlights the importance of systematic image screening and thorough interpretation of any potential abnormality in the craniofacial complex since several studies revealed a high prevalence of IFs outside the primary dental focus [23; 24]. A study by [PERSON] et al. [37] reported that 66% of the findings occurred distant from the dentition and suggested that a markedly higher prevalence of IFs located in extra-dental regions is expected as patients' age increases. After dentition, paranasal sinuses are the next most common anatomical locations, where IFs were found at 52.6% in a cleft sample [14]. Our study confirmed the same trend since 54.3% of cleft patients presented findings in paranasal sinuses, such as mucosal thickening, antral polyps, antrolith, sinusitis, pansinusitis, and retention cysts. In the control group, we reported a 2.7% rate of IFs in paranasal sinuses, a striking difference from the 14.2-59.7% demonstrated in the literature [15; 22; 24; 47]. This discrepancy may indicate the different imaging indications implemented in each study sample. Temporomandibular joint abnormalities were observed at a high rate in the cleft and control groups in our analysis, with a rate of 47.1% and 14.7%, respectively. [PERSON] et al. [14] did not detect any finding in the TMJ region of cleft patients, while studies on non-cleft populations found the rate of incidental TMJ findings to be 4.3% [15] to 11.1% [20]. Four CBCT studies on non-cleft samples [15; 20; 21; 23] detected a variety of abnormal findings (coronoid hyperplasia, condylar hyperplasia, condylar hypoplasia), physiological remodeling (flat condylar margins, subchondral sclerosis), and degenerative alterations (osteophytes, erosions) affecting the TMJ structures. According to our results, findings in the nasal cavity were present in 75.8% of the cleft patients and 1.49% of the controls. Nasal septum deviation constituted most of the detected findings in the nasal cavity of our sample. This abnormality is mentioned as the most common finding concerning the nasal cavity in patients with CL/P [14], with a prevalence of 34% [25], and is also considered to increase with age [48]. Prevalence rates in former studies on non-cleft subjects range from 0.4 to 56.7% [15; 20; 48]. Soft tissue calcifications were incidentally detected in 7.69% of both groups in our study, which was lower compared with former studies. CBCT studies indicated that soft tissue calcifications were present in 20% [24] of healthy non-cleft samples, with tonsilloliths, sialoliths, thyroid cartilage, and carotid artery calcifications as the most prominent findings [23; 24].