Kuijpers Mette A R, Pazera Andrzej, Admiraal Ronald J, Bergé Stefaan J, Vissink Arjan, Pazera Pawel
Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Cleft Palate Craniofacial Unit, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Clin Oral Investig. 2014 May;18(4):1237-1244. doi: 10.1007/s00784-013-1095-z. Epub 2013 Aug 27.
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.
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.
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.
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.
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.
锥形束计算机断层扫描（CBCT）常用于唇腭裂（CLP）患者的牙槽骨移植（ABG）和正颌外科手术的治疗规划。CBCT图像可能显示出一些偶然发现。本研究的目的是评估CLP患者CBCT扫描中偶然发现的发生率。
对2006年1月至2012年6月期间连续收治的187例非综合征性口腔颌面部裂隙患者（平均年龄11.7岁，范围6.9 - 45岁）的初始CBCT进行系统评估。28例患者（平均年龄19.3岁，范围13.2 - 30.9岁）在首次进行CBCT检查前已接受ABG；61例患者在ABG前后均进行了CBCT检查。检查鼻窦、鼻咽、口咽、喉部、颅骨、椎体、颞下颌关节（TMJ）、上颌骨和下颌骨是否有偶然发现。
在95.1%的CBCT中发现了偶然发现。最常见的是气道/鼻窦发现（56.1%），其次是牙齿问题，如牙齿缺失（52%）、鼻中隔偏曲（34%）、中耳和乳突混浊，提示中耳炎（10%）和（慢性）乳突炎（9%）、TMJ解剖结构异常（4.9%）和椎体解剖结构异常（1.6%）。在28例首次CBCT检查在ABG后至少2年进行的患者中，除12例双侧CLP患者中的2例，重建裂隙区域仍有骨组织存在。超过50%的患者仍可识别ABG供区（所有骨移植均取自颏部区域）。根据CBCT检查结果，10%的患者被转诊进行进一步诊断，9%的患者因牙齿问题被转诊进行进一步治疗。
CBCT上的偶然发现很常见。与文献相比，CLP患者有更多的牙齿、鼻腔和耳部问题。因此，只要有CBCT，CLP团队的所有专科医生都应根据他们关于这些患者症状和治疗的特定背景知识对该扫描进行评估。
大量的发现表明，CBCT成像不仅在CLP患者的牙槽骨移植和正颌外科手术治疗中是一种有用的工具；它还为几乎所有参与CLP治疗的专科提供诊断信息。
