Publications by authors named "Lindsay Schuster"

12 Publications

  • Page 1 of 1

Dens Invaginatus in Patients With Cleft Lip and Palate: A Case Series.

Cleft Palate Craniofac J 2021 Mar 5:1055665621998534. Epub 2021 Mar 5.

6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

Dens invaginatus is a rare developmental anomaly characterized by an infolding of the enamel organ within the crown or root of a tooth, and it is an example of a dental anomaly that has a higher incidence in patients with CL/P. If undiagnosed, dens invaginatus can lead to severe, acute pain and pulpal necrosis since it can permit direct entry of bacteria into the dental pulp. Treatment of dens invaginatus includes prophylactic sealant or composite restoration, endodontic therapy if pulpal involvement has already occurred, or extraction if aberrant tooth morphology precludes endodontic therapy. Few studies report on the incidence of dens invaginatus in patients with CL/P. The purpose of this article is to describe 4 cases of dens invaginatus in patients with CL/P which were encountered in a cleft-craniofacial orthodontic clinic. Each case describes dens invaginatus in a maxillary lateral incisor, and treatments ranged from sealant application to endodontic therapy to extraction. These cases highlight the importance of awareness of this dental anomaly among cleft team providers to facilitate early diagnosis in patients with CL/P.
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http://dx.doi.org/10.1177/1055665621998534DOI Listing
March 2021

Musculoskeletal Pain Survey Outcomes in Cleft Surgeons and Orthodontists.

Cleft Palate Craniofac J 2021 Feb 6;58(2):222-229. Epub 2020 Aug 6.

72058University of Pittsburgh Medical Center Children's Hospital, PA, USA.

Objective: Determine prevalence and characteristics of musculoskeletal pain and pathology in cleft providers.

Design: An IRB-exempt survey based on previously validated surveys was administered. Data collected included demographics, practice description, musculoskeletal pain history, formal diagnoses, and interventions.

Setting: Survey was sent to all cleft centers approved by the American Cleft Palate-Craniofacial Association worldwide.

Patients, Participants: All cleft surgeons and orthodontists at these centers met entry criteria. Eighty-three providers responded. Cleft center coordinators were unable to confirm the number of survey recipients.

Main Outcome Measures: The hypothesis formulated prior to data collection was that prevalence would be comparable to general plastic surgeons and other at-risk health care providers.

Results: Average age of respondents was 49.8 ± 11.3 years; 33.9% of respondents were female. Average body mass index was 24.8 ± 3.5 kg/m. Headaches were observed in 62.7% of surveyed respondents while musculoskeletal symptoms were reported in 89.8%. Of the 12 body parts addressed, most commonly affected were the neck (71.2%), shoulders (52.5%), and lower back (67.8%). Pain interfered with hobbies and home life in the majority of respondents (62.7%). Those who reported a formal diagnosis were more likely to undergo treatment including surgery ( < .01), medication ( = .03), and physical therapies ( < .01).

Conclusions: Cleft surgeons and orthodontists experience a higher frequency of headaches compared to the general population, and musculoskeletal disorders are more prevalent than reported by general plastic surgeons. Pain interferes with hobbies and home life. Formal diagnosis leads to treatment. Preventative exercises and interventions are presented.
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http://dx.doi.org/10.1177/1055665620946184DOI Listing
February 2021

Cone-Beam Computed Tomography Incidental Findings in Individuals With Cleft Lip and Palate.

Cleft Palate Craniofac J 2020 04 22;57(4):404-411. Epub 2020 Jan 22.

UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

Objectives: The use of cone-beam computed tomography (CBCT) is well-established in clinical practice. This study seeks to categorize and quantify the incidental finding (IF) rate on CBCT in patients with cleft lip and palate (CLP) prior to orthodontic or surgical treatment.

Methods: This is systematic retrospective review of head and neck CBCTs in patients with nonsyndromic CLP taken between 2012 and 2019 at a single tertiary referral center. All assessments were performed independently by 4 observers (a head and neck radiologist and 3 orthodontists, including 2 fellowship-trained cleft-craniofacial orthodontists ). The images were divided into 9 anatomical areas and screened using serial axial slices and 3D reconstructions. The absolute number of IFs was reported for each area and statistical analysis was performed.

Results: Incidental findings were found in 106 (95.5%) of the 111 patients. The most common sites were the maxilla (87.4%, principally dental anomalies), paranasal sinuses (46.8%, principally inflammatory opacification), and inner ear cavities (18.9%, principally inflammatory opacification). Eleven patients had skull malformations. Thirty-three patients had IFs in 1 anatomical area, 49 patients in 2 anatomical areas, 19 patients in 3 areas, and 5 patients presented with IFs in 4 of the 9 anatomical areas.

Discussion: In patients with CLP, IFs on CBCT exam were present in the majority of cases. Most patients with IFs had them in multiple anatomical areas of the head and neck. The maxillary dental-alveolar complex was the most common area. Inflammatory changes in the inner ear cavities and paranasal sinuses were also common; however, cervical spine and skull abnormalities were also identified. Clinicians caring for patients with CLP should be aware of IFs, which may warrant further investigation and treatment.
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http://dx.doi.org/10.1177/1055665619897469DOI Listing
April 2020

Relationship of Velopharyngeal Insufficiency With Face Mask Therapy in Patients With Cleft Lip and Palate.

Cleft Palate Craniofac J 2020 01 31;57(1):118-122. Epub 2019 Jul 31.

UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

Objective: To determine whether orthodontic/dentofacial orthopedic maxillary protraction face mask therapy induces changes in velopharyngeal functioning in a cohort of pediatric patients having cleft palate with or without cleft lip.

Design: Retrospective chart review.

Setting: A children's hospital in the United States.

Participants: Forty-three pediatric patients with cleft palate, with or without cleft lip, syndromic or with isolated clefts, who received face mask therapy from January 2009 to April 2016.

Intervention: Clinical data were extracted for review and analysis from medical records obtained from the Cleft Database/Research Registry (CDB-RR).

Main Outcome Measures: Pittsburgh Weighted Speech Scores (PWSS) before and after therapy.

Results: There was a significant increase in PWSS after face mask therapy for patients with a PWSS score of 0 prior to treatment. Patients with PWSS >0 before treatment remained largely stable after face mask therapy. Maxillary advancement was not significantly associated with change in PWSS or fistula presence/absence.

Conclusions: There is an increased risk of velopharyngeal insufficiency with maxillary protraction face mask treatment in patients with cleft palate. Patient counseling and obtaining consent regarding speech changes during treatment are recommended.
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http://dx.doi.org/10.1177/1055665619865155DOI Listing
January 2020

Airway Obstruction Risk in Unique Infant Cleft Phenotype: PSIO Protocol Modification Recommendations.

Cleft Palate Craniofac J 2020 02 30;57(2):245-248. Epub 2019 Jul 30.

Department of Plastic Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.

Patients presenting with a unique unilateral cleft phenotype may be at risk of nasal airway obstruction which can be exacerbated by presurgical infant orthopedic (PSIO) appliance therapy and lip taping. Four patients presented to the UPMC Children's Hospital of Pittsburgh Cleft-Craniofacial Center with a cleft phenotype characterized by: An anteriorly projected greater alveolar segment and medial collapse of the lesser segment posteriorly, leading to cleft alar base displacement posteromedial to the anteriorly projected greater segment. Resultant bilateral nasal airway obstruction: cleft ala drape over the leading edge of the greater segment's alveolus (cleft side obstruction) and caudal septum displacement secondary to attachments to the orbicularis oris from the noncleft side (noncleft side obstruction). The patient described presented at 3 months old from an outside institution, where PSIO therapy was undertaken. A second opinion was sought due to concern of significant difficulty in breathing and feeding with the PSIO oral plate. Lip-nose adhesion (LNA) was elected and airway obstruction was immediately relieved after this intervention. Lip-nose adhesion releases the tethered cleft side alar base from the pyriform rim of the posteromedially collapsed lesser segment and unites the superior lip and nostril sill-relieving the cleft side nostril obstruction. During the LNA, the caudal septum is surgically released from the anterior nasal spine and is uprighted, relieving the obstructed noncleft nostril. In this cleft anatomy, the treatment alternatives of modification to the PSIO appliance or LNA should be carefully considered in consultation with the surgeon, PSIO provider, and the infant's caretakers.
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http://dx.doi.org/10.1177/1055665619866354DOI Listing
February 2020

Neonatal Mandibular Molding for Congenital Open Bite: 10-Year Follow-Up.

Plast Reconstr Surg 2019 08;144(2):336e-338e

University of Pittsburgh School of Medicine and Department of Plastic Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa.

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http://dx.doi.org/10.1097/PRS.0000000000005853DOI Listing
August 2019

Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth.

J Neurosurg Pediatr 2019 01;23(4):523-530

Departments of1Plastic Surgery.

Objective: Cranial base development plays a large role in anterior and vertical maxillary growth through 7 years of age, and the effect of early endonasal cranial base surgery on midface growth is unknown. The authors present their experience with pediatric endoscopic endonasal surgery (EES) and long-term midface growth.

Methods: This is a retrospective review of cases where EES was performed from 2000 to 2016. Patients who underwent their first EES of the skull base before age 7 (prior to cranial suture fusion) and had a complete set of pre- and postoperative imaging studies (CT or MRI) with at least 1 year of follow-up were included. A radiologist performed measurements (sella-nasion [S-N] distance and angles between the sella, nasion, and the most concave points of the anterior maxilla [A point] or anterior mandibular synthesis [B point], the SNA, SNB, and ANB angles), which were compared to age- and sex-matched Bolton standards. A Z-score test was used; significance was set at p < 0.05.

Results: The early surgery group had 11 patients, with an average follow-up of 5 years; the late surgery group had 33 patients. Most tumors were benign; 1 patient with a panclival arteriovenous malformation was a significant outlier for all measurements. Comparing the measurements obtained in the early surgery group to Bolton standard norms, the authors found no significant difference in postoperative SNA (p = 0.10), SNB (p = 0.14), or ANB (0.67) angles. The S-N distance was reduced both pre- and postoperatively (SD 1.5, p = 0.01 and p = 0.009). Sex had no significant effect. Compared to patients who had surgery after the age of 7 years, the early surgery group demonstrated no significant difference in pre- to postoperative changes with regard to S-N distance (p = 0.87), SNA angle (p = 0.89), or ANB angle (p = 0.14). Lesion type (craniopharyngioma, angiofibroma, and other types) had no significant effect in either age group.

Conclusions: Though our cohort of patients with skull base lesions demonstrated some abnormal measurements in the maxillary-mandibular relationship before their operation, their postoperative cephalometrics fell within the normal range and showed no significant difference from those of patients who underwent operations at an older age. Therefore, there appears to be no evidence of impact of endoscopic endonasal skull base surgery on craniofacial development within the growth period studied.
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http://dx.doi.org/10.3171/2018.8.PEDS18183DOI Listing
January 2019

Simonart's Band: Its Effect on Cleft Classification and Recommendations for Standardized Nomenclature.

Cleft Palate Craniofac J 2017 11 12;54(6):726-733. Epub 2016 Sep 12.

Objective: Accurate classification of cleft lip plays an important role in communication, treatment planning, and comparison of outcomes across centers. Although there is reasonable consensus in defining cleft types, the presence of Simonart's band can make classification challenging. Our objective was to survey cleft care providers to determine what all consider to be Simonart's band, how its presence effects cleft lip classification, and to provide recommendations for standardized nomenclature.

Design: A multiple-choice survey was e-mailed to 1815 members of the American Cleft Palate-Craniofacial Association, assessing each respondent's definition of Simonart's band and its effect on cleft classification. Cleft classification was drawn from the ICD system diagnosis billing codes. Descriptive analysis was performed.

Results: Three hundred seventy-three providers completed the survey (20.5% response), the majority of whom were surgeons (61.5%); 87.1% agreed with the definition that a Simonart's band is "any soft tissue bridge located at the base of the nostril or more internally, between the segmented ridges." However, only 41.8% felt that the presence of a Simonart's band rendered a cleft lip incomplete; 54.4% felt that an alveolar cleft was the defining difference between a complete and an incomplete cleft lip. When asked to define the child with a cleft involving the upper lip that extends into the naris but interrupted by a soft tissue bridge located only at the base of the nostril or more internally, without a cleft of the alveolar ridge and palate, 61.4% classified this as an incomplete cleft lip, 32.7% as a complete cleft lip, and 5.9% as an unspecified cleft lip.

Conclusions: Responses revealed wide discrepancy in the classification of cleft phenotypes and in the interpretation of the significance of anatomical components in the classification of a cleft lip. We discuss the difficulty in aligning classification based on unclear definition of terms and variable anatomic parameters. We highlight this issue in the face of a need for comparability in clinical evidence-based practices. To ensure precision and uniformity in cleft classification, we recommend that use of the term "Simonart's band" be abandoned while incorporating a notation of the integrity of the nasal sill into the LAHSHAL system. We propose a uniform definition of incomplete versus complete cleft lip, wherein a cleft lip will be classified as complete in the presence or absence of narrow bands of tissue present at the base of the nasal sill or more internally.
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http://dx.doi.org/10.1597/15-319DOI Listing
November 2017

Severe Pediatric Midface Trauma: A Prospective Study of Growth and Development.

J Craniofac Surg 2015 Jul;26(5):1523-8

*Department of Plastic Surgery, Division of Pediatric Plastic Surgery, University of Pittsburgh, Pittsburgh, PA †Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA ‡Division of Plastic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON.

Severe pediatric facial trauma is characterized by multiple, comminuted, and unstable fractures, frequently necessitating operative intervention. Disruption of facial growth is a primary concern in the long-term sequelae of such conditions. Children suffering from midface fractures were followed over time in a long-term growth and development study. Lateral cephalograms at longest-term follow-up were traced, digitized, and averaged. Seven landmarks of the midface (A point, ANS, orbitale, bridge of nose, distal U6, upper lip, stomion superius) were identified for comparative measurements with age and sex-matched superimposed Bolton norms as controls. Differences in x and y axes between test and control metrics were measured. Clinical significance was defined as a 2-mm discrepancy from the norm. Statistical significance for each patient was determined using t tests of the x and y arrays of patient values versus normal controls. Seven patients met the inclusion criteria with mean age of 8.9 years at the time of injury. Mean cephalometric follow-up was 4.6 years (range 2-10 years). Six out of 7 patients (86%) showed clinically significant impairment in growth in horizontal (29%), vertical (29%), or both planes (29%). T Tests confirmed statistical significance (P ≤ 0.05) for all clinically significant differences. Mean deficiency in growth for all landmarks was 3.7  mm (range -4.0 to 13.7  mm) in the x axis and 2.9  mm (range -1.1 to 8.8  mm) in the y axis. Severe pediatric midface trauma often results in compromised bone growth and permanent facial deformity. New methodologies of management that better allow for growth are needed.
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http://dx.doi.org/10.1097/SCS.0000000000001818DOI Listing
July 2015

Management of the alveolar cleft.

Clin Plast Surg 2014 Apr;41(2):219-32

Craniofacial Orthodontics, Department of Orthodontics, Georgia Regents University, 1120 15th Street, Augusta, GA 30912, USA.

Orthopedic and orthodontic management of patients born with clefts of the lip, alveolus and palate is based on the application of basic biomechanical principles adapted to the individualized cleft anatomy. This article focuses on orthopedic and orthodontic preparation for 2 stages of interdisciplinary orthodontic/surgical cleft care: presurgical infant orthopedics (nasoalveolar molding) for lip/alveolus/nasal surgical repair and maxillary arch preparation for secondary alveolar bone grafting. These preparatory stages of orthopedic/orthodontic therapy are undertaken with the goal of restoring normal anatomic relationships to assist the surgeon in providing the best possible surgical care.
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http://dx.doi.org/10.1016/j.cps.2014.01.001DOI Listing
April 2014

215 mandible fractures in 120 children: demographics, treatment, outcomes, and early growth data.

Plast Reconstr Surg 2013 Jun;131(6):1348-1358

Pittsburgh, Pa. From the Children's Hospital of Pittsburgh.

Background: Optimal management of pediatric mandible fractures demands that the practitioner balance reduction and fixation with preservation of growth potential and function. The ideal synthesis of these goals has not yet been defined. The authors catalogue their experience with pediatric mandible fractures at a major pediatric teaching hospital with reference to demographics, injury type, treatment, and outcomes to inform future management of these injuries.

Methods: Demographics, management, and outcomes of pediatric mandible fractures presenting over 10 years at a pediatric trauma center were assessed. Cephalometric analysis was conducted. Relationships among demographics, fracture type, management, outcomes, and growth were explored.

Results: Two hundred fifteen mandible fractures in 120 patients younger than 18 years were analyzed (average follow-up, 19.5 months). The condylar head and neck were fractured most frequently. Operative management was significantly more likely for children older than 12 years (p<0.05). Operative management and multiple fractures were significantly associated with a higher rate of adverse outcomes (p<0.05), but no adverse outcomes were considered to significantly affect mandibular function by patient or surgeon. No significant growth differences existed on cephalometric analysis between our cohort and age- and sex-matched controls (p>0.05).

Conclusions: This study reports the demographics, treatment, and early follow-up of a sizable cohort of pediatric mandible fractures. Management principles for these injuries are outlined. Although definitive recommendations must be withheld until longer follow-up is available, the data presented here show that the treatment protocols used at the authors' center have yielded largely uncompromised mandibular function and growth thus far.
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http://dx.doi.org/10.1097/PRS.0b013e31828bd503DOI Listing
June 2013

Information-seeking and decision-making preferences among adult orthodontic patients: an elective health care model.

Community Dent Oral Epidemiol 2011 Feb 23;39(1):79-86. Epub 2010 Aug 23.

Division of Orthodontics, University of Minnesota, Minneapolis, MN 55455, USA.

Objectives: When it comes to their own health care, adult patients traditionally demonstrate strong information-seeking desire but a somewhat lower desire to make their own treatment decisions in nonelective situations. Little is known about these desires in patients facing elective health care situations. We used the well-tested Autonomy Preferences Index (API) as a base to construct and test our elective Autonomy Preferences Index (eAPI) for both information-seeking and decision-making and analyzed demographic variables on both.

Methods: The eAPI was constructed to mirror the API but uses elective scenarios rather than the API's nonelective scenarios. It was validated using cognitive interviews to determine item intent and comprehension and by Cronbach's alpha. Both the API and eAPI were distributed to 188 active-treatment patients at the Division of Orthodontics, University of Minnesota. API and eAPI items were scored using a 1 (low) to 5 (high) Likert scale of desire.

Results: Mean information-seeking desire was universally high (>4, P < 0.001) for both API and eAPI instruments. Mean decision-making (DM) desire was universally low to moderate: API-DM = 2.84 and eAPI-DM = 2.6. Decision-making preferences for nonelective items (API-DM) decreased as the condition severity presented in the vignettes increased: mild = 2.88, moderate = 2.67 and severe = 2.21. Conversely, elective decision-making preferences (eAPI-DM) increased with increasing condition severity: mild = 2.51, moderate = 2.79 and severe = 3.18 (P < 0.001).

Conclusions: Adult patients have universally high information-seeking preferences and moderate to low decision-making preferences regardless of the elective or nonelective nature of their condition. However, as vignette condition severity increases, patients facing nonelective scenarios display progressively less desire for decision-making, whereas patients facing elective scenarios show progressively more decision-making desire.
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http://dx.doi.org/10.1111/j.1600-0528.2010.00572.xDOI Listing
February 2011