# Incidental Findings in Patients with Cleft Lip and Palate: A Case-Control Study
## 4 Discussion
(90.7%) [24] and higher than the 21.4% presented in other research reports [15; 36; 37]. Such variability in findings can be attributed to the various imaging techniques implemented in former investigations. Researchers have evaluated IFs in cleft or non-clft orthodontic populations based on either 2D imaging, namely panoramic and lateral cephalometric radiographs [10; 27; 28; 29; 30; 37; 38], or 3D techniques with CBCT or CT scans [15; 20; 21; 22; 23; 36; 41]. In addition, there are different indications for a radiograph or a scan in the existing literature, and other study populations analyzed in various settings could eventually result in fluctuating rates of IFs. Further discrepancies could be observed due to varying age, diagnostic criteria, and total sample size. No correlation between IFs and gender was found in the case and the control group. After evaluating the prevalence of IFs by cleft type, we concluded that most cleft patients belonged to the CLP-UL subgroup (40%), which is in line with other research analyses [30; 41; 42]. According to the literature, IFs are more frequently observed in the dental rather than the extra-dental regions. In previous investigations of non-clft orthodontic samples [36; 37], most IFs occurred in the dentition, followed by nasal and paranasal sinuses. We confirmed that the most common anatomical location that demonstrated IFs in the case group was the maxilla, followed by the nasal cavity, mandible, and paranasal sinuses. In the control group, a higher prevalence of IFs was presented in the maxilla, followed by the mandible, TMJ, and paranasal sinuses. In addition, we reported IFs in the nasal cavity and paranasal sinuses common in both case and control groups that could lead to severe esthetic and functional implications for the patient. Such IFs are the enlarged inferior nasal concha in the nasal cavity, which often requires rhinoplasty and mucosal thickening, retention cysts, and obstructed sinus in the paranasal sinuses, which could be associated with higher risk of inflammation. Our study confirmed the theory supported by [PERSON] that the impact of orofacial clefts is more localized on the cleft area than generally on the dentition [38]. Regarding the IFs in the dentition, our analysis revealed significantly higher prevalence rates in cleft patients' maxilla and mandible compared to non-clft subjects. It is noteworthy that IFs in the mandible were documented in 63.2% of the cases in contrast with 41.3% of the controls. Moreover, we observed significantly fewer IFs in the mandible than in the maxilla of patients with CL/P since the former presented a mean number of findingsof nearly half the number in the latter. Therefore, we can infer that orofacial clefts may affect anatomical structures outside the cleft's area, particularly the mandible, yet only to a limited degree. A meta-analysis conducted by [PERSON] et al. [26] included 26 studies with 15,213 participants and assessed the frequency of dental anomalies between non-syndromic cleft patients and individuals without clefts. The results suggested a positive association between orofacial clefts and dental abnormalities, which is accounted for surgical interventions, such as primary lip and secondary palate surgery, that may prompt teeth displacement and rotation or affect the development of anterior and posterior permanent teeth [26]. [PERSON] et al. showed that tooth agenesis was the most commonly reported dental abnormality. Our investigation revealed that 72.5% of the orofacial cleft patients presented with tooth agenesis and were in line with several studies [23; 26; 27; 28; 29] demonstrating a high rate of tooth agenesis in patients with CL/P. In our sample, the highest prevalence of tooth agenesis among cleft cases (excluding third molars) was reported for maxillary permanent lateral incisors in the cleft area, the second maxillary premolars, and the second mandibular premolar outside the cleft area.