# Incidental Findings in Patients with Cleft Lip and Palate: A Case-Control Study
###### Abstract  
Incidental findings (IFs) depicted in imaging tests during the diagnostic evaluation of patients with cleft lip and/or palate (CL/P) can guide clinicians during treatment planning procedures for effective, comprehensive cleft care. Evidence regarding IFs in different anatomical regions distant from the dentition is scarce. The aim of this study was to compare the prevalence of IFs in various anatomical areas between patients with non-syndromic CL/P and unaffected subjects. Orthopontomographs (OPTs), lateral cephalometric (LC) radiographs, and cone beam computed tomography (CBCT) scans of 120 subjects (case group: \(n=40\), 18 females, age 14.5 \(\pm\) 5.0 years; control group: \(n=80\), 36 females, age 14.6 \(\pm\) 4.9 years) were examined, and IFs were assessed by four observers. A significantly higher prevalence of IFs (\(p<0.001\)) was reported in the case group (97.5%) compared with the control group (62.5%). The most prevalent location of IFs in the case group was the maxilla (92.5%), followed by the nasal cavity (75.8%) and the mandible (63.2%), while in the control group, the highest rates of IFs occurred in the maxilla (43.8%), mandible (41.3%), and temporomandibular joint (TM) (14.7%). No gender-dependent pattern for IF occurrence was detected overall. Orofacial clefts may affect the mandible. However, the reported IFs were limited compared to those in the maxilla. In conclusion, individuals with CL/P are more likely to present with a range of IFs than their unaffected peers. Understanding the association between CL/P and IFs is critical for successful interdisciplinary treatment, raising awareness of the potential need for future dental care for cleft patients, and managing extra-dental aberrations. A systematic assessment of diagnostic records is required to eliminate the risk of overlooking clinically significant IFs. resulting in severe craniofacial deformity [1; 2]. CL/P is one of the most common congenital defects affecting the craniofacial structures, with an overall incidence of approximately 1.5 per 1000 live births (about 220,000 new cases per year) [3]. CL/P is a multifactorial condition, and identifying its specific etiologic factors has proven difficult. Since this disease arises in the early stages of embryological development, it appears to result from the interaction of genetic and environmental factors [3; 4; 5; 6]. Mutations in numerous genes, such as interferon regulatory factor 6 (IRF-6) and Msh homeobox 1 (MSX1) genes, which play a critical role in embryonic development, contribute to the disorder's complex etiology [4]. Most CL/P cases (approximately 70%) are non-syndromic, where CL/P occurs as an isolated entity with no other apparent cognitive or craniofacial structural abnormalities [4]. The internationally accepted incidence of non-syndromic CL/P is 1 in every 1000 births [7]. An incidental finding (IF) is defined as any normal variant, benign, or pathological finding randomly discovered and unrelated to the clinical indication by which the imaging test was originally prescribed [8]. Orthodoxists request routine imaging tests, which include panoramic radiographs/orthopantomography (OPT) and lateral cephalometric (LC) radiographs for diagnostic and treatment planning purposes. These imaging techniques are two-dimensional (2D), with low radiation doses for orthodontic patients, and may reveal abnormalities or pathological findings in structures of the maxillofacial complex [9]. In several cases, IFs might be missed with 2D radiographs, but they can be detected and diagnosed accurately by three-dimensional (3D) images such as cone beam computed tomography (CBCT) [10]. This could also be attributed to the lack of clinicians' experience with interpreting anatomical structures that are not directly related to their primary area of interest on a radiograph [11].