Mette A R Kuijpers1,2, Andrzej Pazera3, Ronald J Admiraal4,5, Stefaan J Bergé4,6, Arjan Vissink7, Pawel Pazera8. 1. Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. m.kuijpers@dent.umcn.nl. 2. Cleft Palate Craniofacial Unit, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. m.kuijpers@dent.umcn.nl. 3. Department of Radiology, Hospital of Neuchâtel, 2300, La Chaux-de-Fonds, Switzerland. 4. Cleft Palate Craniofacial Unit, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. 5. Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, 377 KNO, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. 6. Department of Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, 590 MKA, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. 7. Department of Maxillofacial Surgery, University Medical Centre Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. 8. Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
Abstract
OBJECTIVES: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVES: 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 CLPpatients. 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. RESULTS: 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. CONCLUSION: Incidental findings are common on CBCTs. Compared with the literature, CLPpatients 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 CLPpatients not only related to alveolar bone grafting and orthognathic surgery but it also provides diagnostic information for almost all specialties involved in CLP treatment.
Authors: Joanneke M Plooij; Thomas J J Maal; Piet Haers; Wilfred A Borstlap; Anne Marie Kuijpers-Jagtman; Stefaan J Bergé Journal: Int J Oral Maxillofac Surg Date: 2010-11-20 Impact factor: 2.789