# Incidental Findings in Patients with Cleft Lip and Palate: A Case-Control Study
## 2 Materials and Methods
### Data Collection and Radiographic Evaluation  
The OPT, LC radiographs, and CBCT scans were taken by expert radiology staff in the Department of Radiology of the School of Dentistry, National and Kapodistrian University of Athens, as part of the orthodontic diagnostic process and treatment planning and not for this study. During the radiographic examination of all participants, the same equipment [Planmeca PM2002 CC (Planmeca Oy, Helsinki, Finland)] and standardized method (67 kV, 5.0 mA, 13.9 s) were implemented. All radiographs were taken according to the ALARA (as low as reasonably achievable) principle with an indication justifying radiation exposure. Patient characteristics (individual patient file number, age, gender, exam date) and all the IFs found during the radiographic evaluation were recorded on spreadsheets originally designed for this study in Microsoft\(\copyright\) Excel\(\copyright\) 365 software (version 16.82 for Mac; Microsoft Corp., Redmond, WA, USA). Chronologic age was calculated by subtracting the date of birth from the date of imaging examination, namely either OPT or CBCT, and it was presented as a decimal age. The data were collected after thoroughly examining the patient's records, including intraoral photographs, charts, OPT and LC radiographs, in addition to CBCT scans, if available. Each IF that was detected during screening was quantified as one finding in the respective anatomical area that was identified. Therefore, IFs were scored in absolute numbers. The findings were based only on a review of the OPT, LC radiographs, and CBCTs and were not influenced by what is reported as a clinical observation/finding in the patient's medical chart. All images were assessed independently by four observers [two oral and maxillofacial radiologists (N.C. and K.B. ), an orthodontisti (I.S. ), and a dental surgeon with three years of experience (I.P.)] under standardized conditions in the same examination setting. In the case of disagreement between the observers, consensus was reached by discussion. Unclear findings were further clarified with the assistance of an experienced oral and maxillofacial radiologist (A.M.). Ten anatomical areas were screened, and the images were reviewed for anomalies in the (i) maxilla, (ii) mandible, (iii) paranasal sinuses, (iv) middle and inner ear cavity, (v) nasal cavity, (vi) orbit, (vii) skull, (viii) cervical spine, (ix) TMJ, and (x) soft tissue. The types of IFs investigated in the present study are depicted in Supplementary Table S1. The following types of dental anomalies/aberrations in the dental development of the maxilla and mandible were screened:  
1. Variations in the number of teeth: teeth agenesis (anodontia, hypodontia, or oligodontia) and supernumerary tooth (supplemental tooth, mesiodens, paramolar, or distomolar);
2. Variations in the morphology of teeth: developmental enamel defects (hypoplasia and/or hypocalification), microdontia, peg-shaped teeth, tautorontism, root ollaceration, dens invaginatus (dens in dente), dens evaginatus, dentine dysplasia, teeth fusion, tooth germination, curved maxillary central incisors, macrodontia, compound odontoma, dentinogenesis imperfeta, amelogenesis imperfeta;
3. Variations in tooth position include tooth transposition, malposition (including ectopic teeth), rotation, and impaction (including third molars);
4. Other abnormalities, such as the presence of mandibular tori, were also reported. IFs that were studied in paranasal sinuses included retention cysts, obstructed sinuses, inflammatory opacification of the mucosal lining (which may suggest localized sinusitis), mucosal thickening of all the sinuses (which is indicative of pansinusitis), mucous retention pseudocysts, antral polyps, concha bullosa, oroantral fistula, and antrolith. The middle and inner ears were assessed for inflammatory or abnormal congenital conditions, middle ear opacification, and a severely underdeveloped vestibular system, suggesting a high likelihood of conductive and/or sensorineural hearing loss.