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Blackwell Publishing AsiaMelbourne, AustraliaANSANZ Journal of Surgery1445-21971745-4581Blackwell Publishing 2008? 200878s1A37A40Blackwell Publishing 2008BREAST SURGERY ANZ J. Surg. 2008; 78 (Suppl. 1)RACS

Annual Scientific Congress , 2008

ANZ J. Surg. 2008; 78 (Suppl. 1) A37­A40 Methodology: Retrospective, with study of available medical records and available consultant databases from 2000 to 2007. Results: Several common factors were identified in the cohort studied: young, Indigenous males, single, with a history of alcohol and/or other substance abuse tended to predominate. Conclusion: It is feasible that with the assistance of a psychologist, patients at risk for recurrent mandibular fractures can be identified and appropriately counseled.

Craniomaxillofacial Surgery (ANZCMFS)

CM01 LONG TERM FOLLOW UP OF ORBITAL FLOOR FRACTURES R. F. Gilmour, U. Pratap and S. Prowse The Royal Hobart Hospital, Hobart, Tasmania Purpose: Anecdotally silicon is said to be an inferior material when used in the repair of orbital floor fractures. Our study looked at whether there was any basis of truth in this statement. Method: The notes of patients who had undergone surgery at The Royal Hobart Hospital to reduce orbital floor fractures over the past 12 years were analysed. Methods of repair, immediate and late complications were recorded. A telephone interview was carried out to assess the long-term complication rates. Results: 53 patients were included in the study. The average length of follow up was 63 months. Rates of infection (2%), Diplopia (11%) and Enophthalmos (6%) were comparable or less than other published methods. 9 patients had required further surgery. Conclusion: We could not find any evidence that silicon has higher short or long-term complication rates when used to reconstruct orbital floor fractures. CM02 INTERPERSONAL VIOLENCE IS THE LEADING CAUSE OF MAXILLOFACIAL FRACTURES M. J. Woodfield, C. Davis, C. A. Mackinnon, M. Patel, B. Young and S. T. Tan Wellington Plastic, Maxillofacial & Burns Unit, Wellington, New Zealand Purpose: To evaluate the causes and patterns of maxillofacial fractures (MF). Methodology: Patients with MF were culled from our prospective MF Database over a 2-year period to December 2007. Patient demographics, mechanism of injury, fracture pattern, and surgical management were analysed. Results: 328 male and 87 female patients with 454 MF were identified. The causes of MF included interpersonal violence (IPV, 42%), sporting injuries (32%), motor vehicle accident (MVA, 7%), and other accidents (15%). These included nasal (40%), mandibular (19%), zygomatic (15%), orbital floor/wall (12%), maxillary (11%), zygomatic (5%) and frontal (2%) fractures. 60 (14%) patients had more than 1 bone fractured. 319 (77%) patients required reduction and/or internal fixation. IPV was the cause in 155 (47%) males and 17 (20%) females, with 77 (45%) associated with alcohol use. 40% of the MF in males occurred in the 20­30 age group and involved the mandible (34%), nasal bones (33%), zygomatic bone (19%), and orbital floor/wall (9%). Nasal fracture was the most common MF caused by sporting injury in 74 (56%) patients. Rugby caused 12% of all mandibular fractures. 9 patients had pan-facial fractures ­ 4 caused by MVA, 2 IPV, 2 falls and 1 self-harm. Conclusions: IPV has replaced MVA and sporting injuries as the leading cause of MF. It is unclear if this change reflects a more violent society. Since MF caused by IPV is entirely preventable, efforts to bring about societal and legislative change may enable diversion of wasted health care resources to the areas of need. CM03 RECURRENT MANDIBULAR FRACTURES M. E. Thomas, J. P. Curtin and C. Scott Royal Darwin Hospital, Darwin, Northern Territory Purpose: Almost 40 patients with recurrent mandibular fractures have been treated in the Royal Darwin Hospital in the last eight years. Is this a preventable disease?

CM04 MANDIBULAR RECONSTRUCTION ­ THE TURN OF THE WHEEL T. Y. Chou, Z. Moaveni and C. Mcewan Waikato Hospital, Hamilton, New Zealand Purpose: Vascularized osseous flaps are the gold standard for composite mandibular reconstruction ­ fulfilling structural, functional and aesthetic goals. Osseocutaneous flaps such as fibula, iliac crest, scapula and radial forearm have their strengths and limitations. This study aims to ascertain the types of microvascular flap used and also the emerging trend of techniques at our unit. Methodology: Retrospective analysis of twenty cases of mandibular reconstruction requiring free osseocutaneous flap between 1997­2007; focusing on flap viability, complications and functional status as the main outcome measures. Indications for surgery included malignancy and osteoradionecrosis. Complications such as flap loss, infection and donor site morbidity, plus variables that may affect flap viability were recorded. Results: The twenty osseocutaneous flaps were 6 fibula, 10 iliac crest, 3 radial forearm and 1 scapula. Complications relating to flap viability consist of 2 total soft tissue loss, 1 anastomotic revision, 4 partial soft tissue loss and 1 non-union of transferred radius. Other complications included orocutaneous fistulae, infection and donor site fracture non-union. Trismus, supplemental nutrition, speech and swallowing were part of the functional outcome measures. Conclusion: Osseocutaneous flaps have found wide application in mandibular reconstruction, providing a good vascular supply and allowing selection of a donor site best suited to the defect. The study demonstrates the evolution, or perhaps the "revolution", of methods of mandibular reconstruction ­ from free iliac crest to radial forearm and fibula, then coming full circle back to vascularized iliac crest flap.

CM05 HAEMATOLOGICAL MANAGEMENT IN JACOBSEN SYNDROME ALLOWS AGGRESSIVE SURGICAL PROCEDURES J. T. Perron and R. Theile Royal Childrens Hospital Brisbane, Queensland Purpose: Jacobsen syndrome, or 11q deletion syndrome, is a complex genetic syndrome requiring a multi-disciplinary approach for care. Performing surgery on individuals with this syndrome is challenging due to the presence of thrombocytopenia. We performed cranioplasties on 2 patients with Jacobsen syndrome, and illustrate how these patients can have a safe and predictable outcome, with a multidisciplinary approach to pre-operative, intraoperative, and post-operative management when compared to non-affected peers. Methodology: Patients were referred to the Haematology and Anaesthetics outpatients at the Royal Children's Hospital in Brisbane pre-operatively. Cross-matched platelets were given pre-, intra-, and post-operatively for both patients. Blood was replaced as necessary during the procedures. Results: Blood loss during the procedures was comparable for the syndromic, and non-syndromic patients. The administration of platelets for the Jacobsen's syndrome patients was the most significant difference (383 mls vs 69.44 mls). Saline, packed red blood cells, fresh frozen plasma, and albumin were comparable between the two groups. Conclusion: Appropriate hemaological management allows usual aggressive remodelling procedures without an increase in mortality/mortality in these cases.

Journal compilation © 2008 The Royal Australian and New Zealand College of Surgeons

A38 CM06 ENTERIC DUPLICATION CYST OF THE ORAL CAVITY WITH ASSOCIATED CLEFT PALATE: CASE REPORT AND REVIEW OF THE LITERATURE S. R. Zilko, D. Gillett, N. Smith, F. Lannigan, M. Walters and M. Strahan Princess Margaret Hospital for Children, Perth, Western Australia Purpose: Enteric duplication cysts (EDCs) are lesions lined by gastrointestinal epithelium that are embryological remnants adherent to the alimentary tract. EDCs have been reported occurring anywhere from the oral cavity to the rectum, sometimes in association with other abnormalities such as an intraosseous component or cleft palate. In the context of a new case of EDC, with apparently unique features, we examined the literature about such lesions and the possible mechanisms leading to their formation. Methodology: Case report and literature review. Results: EDCs of the oral cavity are exceedingly rare lesions, with less than fifty cases previously reported. Most describe lesions comprising heterotopic gastrointestinal mucosa. There are several reports of EDCs lined with both gastrointestinal and respiratory epithelium, with one case reporting gastrointestinal and pancreatic tissue. The present case represents the first report to our knowledge of a mixed EDC comprising gastrointestinal, respiratory, and pancreatic (both exocrine and endocrine) tissue in the oral cavity, in association with a cleft palate. Conclusion: The possible aetiology of this rare lesion is discussed with respect to previously reported cases as well as current theories of gut and cleft palate embryogenesis. CM07 EVOLUTION OF SURGERY FOR SAGITTAL SYNOSTOSIS ­ THE ROLE OF NEW TECHNOLOGY K. A. Mackenzie, C. Davies and M. R. Macfarlane Christchurch Hospital, Christchurch, New Zealand Purpose: Techniques for sagittal synostosis correction continue to evolve in order to improve outcomes and minimize morbidity. The techniques used by our craniofacial service are spring assisted cranioplasty for children less than 9 months of age and biparietal barrel staving with Macropore struts for older children. We wished to evaluate the evolution and rationale of our current methods of treatment. Method: All patients receiving surgery for craniosynostosis over the period 1982 to 2006 were retrospectively reviewed. Patients with sagittal synostosis were analysed according to the type of operative procedure performed. Blood loss, operative time, and hospital stay were compared between techniques using ANOVA. Results: 67 patients had a cranial vault remodelling procedure for craniosynostosis. 30 patients had a sagittal synostosis. During the period 1982­2001 12 patients had a strip craniectomy and 5 patients had a barrel stave and morcellation procedure. In 2001 the Macropore strut technique evolved and has been used in 7 patients. In 2005 the spring cranioplasty technique was introduced and has been used in 5 patients. There were no deaths and no serious complications. One patient treated with springs had a second spring procedure performed to further increase biparietal width. Spring assisted cranioplasty had a significantly shorter operating time than other techniques (p < 0.01). Conclusion: The availability of absorbable plates and expansile cranial springs has revolutionized the techniques our unit uses for scaphocephaly correction. Our early experience with these techniques has shown that the techniques are reliable and give good cranial shape and form with minimal treatment morbidity.

ANZ J. Surg. 2008; 78 (Suppl. 1) CM08 `LIKE A HOLE IN THE HEAD' CUTIS APLASIA IN THE PRESENCE OF GIANT PARIETAL FORAMINA; A CASE REPORT HIGHLIGHTING POTENTIAL SURGICAL PITFALLS A. M. Guiney, A. L. Winder and B. J. Nye Christchurch Public Hospital, Christchurch, New Zealand Enlarged Parietal foramina are usually considered a benign calvarial defect. they are due to a variable degree of defective intra membranous ossification of the parietal bones. We report an eight-year old girl who was referred to the Department of Plastic Surgery at Christchurch Hospital with an area of cutis aplasia over the scalp vertex. An incidental finding of adjacent, symmetrical bony defects in the parietal bone was made. These were confirmed as giant parietal foramina on subsequent CT imaging. Literature review highlighted an association with cerebral venous and cortical anomalies with a high incidence of enlarged emissary veins at these sites. This was confirmed on CT imaging. This aberrant vascular foetal development may affect cerebrovascular and skull development. Individuals with enlarged parietal foramina undergoing surgery warrant imaging of underlying brain parenchyma and vasculature. CM09 MODERN FUNCTIONAL AND AESTHETIC TREATMENT OF CRANIOSYNOSTOSIS C. Davis Wellington Regional Plastic & Craniomaxillofacial Unit, Wellington, New Zealand It is now widely accepted that craniosynostosis surgery is performed for both functional and aesthetic reasons. SPECT scanning demonstrates that 70% of cases have cortical perfusion defects adjacent to the synostosis and these defects are corrected after early reconstructive surgery. Meta-analysis of neurodevelopmental studies demonstrate a three- to fivefold increase in the risk for cognitive deficits or learning and language disabilities. New technologies have revolutionized the traditional approaches to craniosynostosis. In our own craniofacial program cranial springs, absorbable plates used as struts and osseodistraction have been a significant advance. This technique of cranial springs was pioneered in Sweden in 1997. The provision of a low grade continuous force causes ongoing biomechanical remodeling in the postoperative period. It has allowed minimalization of the extent of surgery without compromising clinical outcomes. This paper summarizes the experience with the first 100 consecutive cases in Sweden and the first 25 cases in New Zealand. We will discuss the way clinical experience has led to an evolution of the way springs are currently incorporated into clinical use. Based on the unique action of springs we have adapted their use in the protocol of cranial decompression for Apert syndrome obviating the need for very early frontoorbital advancement. Springs are used to remodel the cranium in cases of deformational scaphocephaly and brachycephaly without the need for osteotomies. We have shown the use of this technique to be safe and in selected situations to offer significant advantages over other current methods of treatment. CM10 MINIMAL ACCESS SURGERY VS TRADITIONAL TECHNIQUES ­ USE OF A 3D CAMERA TO MEASURE RESULTS A. F. Breidahl, S. Williams, L. Ellis and G. Williams Royal Children's Hospital, Melbourne, Victoria Minimal access Craniomaxillofacial Surgery, such as the use of springs in craniosynostosis, can greatly reduce the anaesthetic and surgical morbidity and mortality associated with more traditional and extensive techniques. Blood transfusion, which is virtually guaranteed with extensive exposures and procedures, can be all but abolished with minimal access techniques. General acceptance of minimal access surgery in Craniomaxillofacial surgery is however limited by the difficulty in proving that the results of surgery are comparable to more traditional extensive techniques. In terms of results in the appearance of a series of patient's faces, it is often left to the eye of the Journal compilation © 2008 The Royal Australian and New Zealand College of Surgeons

RACS Annual Scientific Congress, 2008 observer to interpret which results are better. A 3-dimensional camera is currently being employed at the Royal Children's Hospital, Melbourne, to try and provide more scientific anthropometic data for analysing results. The 3d camera will be introduced and results of inter-observer and intra-observer error studies, and a comparison with Farkas' anthropometric data will be presented. Acknowledgements: This research was supported by grants from the John T Reid Charitable Trust and the Batten Foundation.

A39 Over the years in our department we have carried out combined craniofacial resection for 40 patients suffering from anterior skull base tumour. In recent years, we have used the endoscopic approach from the inferior aspect whenever appropriate. All our patients survived the operation and 3 patients developed CSF leakages which subsided with conservative treatment. The 5 year actuarial survival was 81% for benign pathologies and 45% for malignant tumours. The results are comparable to the report of 308 patients who had surgery at the Royal National Hospital of Throat, Nose and Ear, London, United Kingdom. The important factors that determine the outcome of the patients are the type of tumour, extent of involvement and surgical clearance. The endoscope will be used more frequently in future as new instruments are developed for resection of tumour at the anterior skull base. The use of navigation system will increase the safety of the endoscopic approaches. The surgical expertise, the stage and nature of tumour, and the condition of the patient will lead to the selection of the best surgical approach for resection of anterior skull base tumour.

CM11 EVALUATION OF FACIAL ASYMMETRIES USING LASER SURFACE SCANNING IMAGES X. Z. Mu and Z. Y. Yu Shanghai 9th Hospital, Shanghai Jiaotong University, Shanghai Purpose: To find out a proper method that may evaluate the severity of facial asymmetry quickly and accessibly in clinics. Methodology: The 3-D image data of facial asymmetry patients were collected with 3-D laser surface scanning, and the desired therapy outcomes were simulated in computers by flip-registration procedure. The discrepancy between desired results and initial images was calculated automatically and a colored hypsography was printed. A questionnaire was given to both the patient and the craniofacial surgeon to exam the symmetry, accessibility, realizability and helpfulness of these outcomes. Results: The 3-D image data offered by laser surface scanning was accurate and convenient. The desired results were reliable and acceptable to the patients. The colored hypsography was clear and accessible, and got high appreciations from the surgeons. Conclusion: 3-D laser surface scanning together with flip registration procedure can evaluate the severity of facial asymmetry quickly, quantitatively, effectively with an achievable outcome. It is welcomed by the craniofacial surgeons and has a great potential in clinic application.

CM13 ASSESSMENT OF AIRWAY STENOSIS IN MIDFACE ADVANCEMENT X. Z. Mu and Z. Y. Yu Shanghai 9th Hospital, Shanghai Jiaotong University, Shanghai Purpose: To evaluate the morphologic and functional changes of airway obstruction in syndromic craniosynostosis after midface advancement in teenage. Methodology: The cephalometric X-ray films, section area and volume measurement according to CT scans, and PSG records were taken. The 2-D measurement of airway included both cephalometric measurement in CT scan. The 3-D measurement of the upper airway was evaluated by the volume of sectional upper airway. The polysomngraphy (PSG) records were compared to indicate the functional changes of airway obstruction. Results: 10 Crouzon Syndrome and 1 Apert Syndrome patients, aged from 6 to 16 years old, accepted midface advancement with distraction osteogenesis. The assessment show that the average ANB angle has been changed from -3.47 +/- 3.60 degrees to 7.16 +/- 3.41 degrees. The average A point (midface) has been moved forwardly 20.27 +/- 8.04 mm. The airway section area at PNS level increased from 68.1 +/- 41.1 mm2 to 278.4 +/- 203.1 mm2 and that at U level changed from 89.6 +/- 72.4 mm2 to 154.8 +/- 68.3 mm2 with a significant statistic difference. The total upper airway volume significantly increased from 14.2 +/- 5.6 ml to 23.3 +/- 11.4 ml after midface distraction osteogenesis. In the PSG records of this group, the apnea hypopnea index (AHI) decreased from 14.1 +/- 9.4/hr to 3.2 +/- 2.2/hr. The SaO2 90% sleeping time shortened from 56.0 +/- 26.5 minutes to 2.9 +/- 2.7 minutes. The snoring index decreased from 95.9 +/- 79.0 to 21.5 +/- 17.6. All morphologic and functional changes in this series presented a significant statistic difference pre- and post-distraction osteogenesis in teenage. Conclusion: Comprehensive assessment are benefit to quantitatively evaluate the results and efficacy of midface advancement with airway obstruction.

CM12 EVOLUTION OF ANTERIOR SKULL BASE SURGERY? MORE OR LESS W. Wei Queen Mary Hospital, Hong Kong Tumours located at the anterior skull base have remained a challenge for the head and neck surgeons. Besides situated in the close proximity to vital organs such as the orbit and brain, the problem is further escalated by the wide range of tumour pathology in the region. Combined craniofacial approach for eradication of tumour is the recognized surgical approach and the technique has evolved over the last forty years, through a number of modifications, to allow more successful eradication of tumour with less trauma delivered to the patient. The superior access to the tumours located at the anterior skull base, has evolved from the creating a bony window of different sizes in the frontal bone to the routine use of a bicoronal flap together with a central inferior craniotomy over the frontal bone. For low lying tumour, the horizontal bar of frontal bone can be removed to increase exposure. The frontal lobe can be lifted to expose the cribriform plate and its vicinity, the posterior limit with this approach is the pituitary fossa. For localized pathologies, rather than using a bicoronal flap, a less extensive approach, such as the subfrontal approach may be adequate. The inferior element of the combined approach may be achieved with endoscopic mobilization of a localized tumour. For tumours with more extensive involvement, the midface deglove procedure gives good exposure. Lateral rhinotomy is useful for tumours that have extended into the upper part of the maxilla. This procedure can be combined with orbital exenteration to treat malignant lesions in that region. The outcome of craniofacial resections for anterior skull base tumours depends on the pathology and extent of the lesion. From an international collaborative study of 17 Institutions which included the database of our department, collecting 1193 patients, the finding was that the open surgical approach has remained as the main stay of surgical treatment. The hospital morbidity (mostly minor) and mortality associated with this type of surgical procedure was around 35% and 5%, respectively.

CM14 CRANIOMAXILLOFACIAL SURGERY ­ THE PAST, PRESENT AND FUTURE D. J. David Australian Craniofacial Unit, Adelaide, South Australia The modern subspecialty of craniomaxillofacial surgery has its origins in the experiences and collaborations formed during the trench warfare on the Western Front in World War I. Major wounds of the head, neck and face were numerous, especially in trench fighting and as a result of shrapnel injury. In France, Germany, Britain and elsewhere, surgeons and dentists collaborated to repair mutilated faces, and special centres were set up to facilitate this. However, few World War I surgeons further developed their knowledge of plastic surgery, neurosurgery and oral surgery in post-war practice. After World War II, this began to gradually change, leading to the current emergence of craniomaxillofacial surgery based in super specialist units. The organization of the present system encompasses all areas of clinical, research, education and technology related to the craniofacial skeleton. Six principles for the delivery of health care to the facial deformed have been

Journal compilation © 2008 The Royal Australian and New Zealand College of Surgeons

A40 developed. A series of long term results presented highlighting the advances and lessons of the last 33 years.

ANZ J. Surg. 2008; 78 (Suppl. 1) cleft lip and palate services and currently deliver outreach programs in the provinces and manage teaching of surgeons in provincial centres. The training of a local cleft team, and commencement of an outreach program has led to equity, participation, and intersectorial collaboration via an integrated approach. The long-term success will depend on a long-term commitment by Interplast Australia and New Zealand, and other international NGO's, a stable local counterpart, a teaching/educational culture, and a management structure that supports sustainability and growth. CM18 TREATMENT OF ARTERIO-VENOUS MALFORMATION S. T. Tan, T. Fitzjohn and D. Davis Hutt Hospital, Wellington, New Zealand Purpose: To present our experience managing patients with AVM. Our philosophy centres on restoration/preservation of quality of life. The indications for definitive treatment included Schoebinger stage III, stage II with ongoing expansion & localized stage I, lesions. Methodology: Consecutive patients with AVM were culled from our Vascular Anomalies Database 1996­2006. Results: 45 (23 M, 22 F) patients with AVM out of 847 vascular anomalies patients were identified. Their mean age was 30.4 (range, 3­62) years with stage III (n = 9), stage II (n = 15) and stage I (n = 21) AVM affecting the head & neck (n = 26), lower (n = 8), upper (n = 8) limb, & trunk (n = 3). 3 patients had multiple AVMs. All 5 patients who became pregnant reported expansion of their AVM during pregnancy. 17 patients with stage III (n = 5), stage II (n = 10) and stage I (n = 2) AVM underwent definitive treatment with surgical excision following pre-operative embolization (n = 10). 15 patients required reconstruction with free flaps (n = 8), local or regional flaps (n = 5), tissue expansion (n = 4), skin grafting (n = 4), tendon transfer (n = 1), and osseointegration (n = 1). 10 patients needed a combination of reconstructive techniques. Complications included exposure of tissue expander (n = 1), stretched scars (n = 2) and haematoma (n = 1). 1 patient developed recurrence which remained quiescent during the followed up (range, 11­112; mean, 65.5 months). Conclusions: AVM is a challenging clinical problem that requires multidisciplinary team approach. Complete surgical excision remains the gold standard treatment and reconstruction forms an integral part of definitive, tailored for individual patients. Our experience shows a recurrence rate of 5.8% over the follow up period. CM19P ESTABLISHING THE BATTEN FOUNDATION 3D IMAGING CENTRE AT THE ROYAL CHILDREN'S HOSPITAL, MELBOURNE L. A. Ellis, S. K. Williams, G. Williams and A. L. Greensmith

CM15 A LATERAL APPROACH AT UPPER CORNER OF ORBIT IN FRONTO-ORBITAL FIBROUS DYSPLASIA X. Z. Mu and Z. Y. Yu Shanghai 9th Hospital, Shanghai Jiaotong University, Shanghai Purpose: To find out the alternative way to gain the better shape on frontoorbital region in fibrous dysplasia. Methodology: A lateral approach at upper corner of orbit was employed in subtotal resection of fronto-orbital fibrous dysplasia. With coronal incision we lift the flap under periosteum and widely exposed the fronto-orbital region. A deep hole has been made with electric saw at the lateral corner between upper orbit rim and temporal fossa. Frontal craniotomy has been made according to the thickness and the mature of local fibrous dysplasia. In the case of severe exophthalmos, it is necessary to remove the upper and later walls of orbit, as well as to keep the fronto-orbit contour with recover the remaining fibrous bone. Results: In our 21 cases series, better shape on fronto-orbit region have been received except 1 case of relapse in teenage. Conclusion: Lateral approach between upper orbital rim and temporal fossa is the way to keep the better shape in fronto-orbital region.

CM16 RESULTS OF PROTOCOL MANAGEMENT OF CROUZON SYNDROME 1975­2008 W. J. Flapper, D. J. David and P. J. Anderson Australian Craniofacial Unit, Adelaide, South Australia Crouzon and Pfeiffer syndromes are two of the commonest craniofacial syndromes characterized in part by craniosynostosis and midface hypoplasia. Optimal management of both of these conditions involves long term input from an integrated multidisciplinary team starting at birth and continuing on till the patient reaches maturity. The Australian Craniofacial Unit has over the last 35 years collected a series of over 100 patients that have reached maturity. The aim of this study is to review this series of patients in terms of their long term outcomes, focusing in particular on psychosocial factors. The results of this study will be useful in demonstrating the effectiveness of a standardized treatment protocol for acrocephalosyndactyly patients and may also give an insight into any changes that could be made to improve patient outcomes.

CM17 LAO PEOPLE'S DEMOCRATIC REPUBLIC (LAO PDR) CLEFT LIP AND PALATE PROGRAM ­ INTERPLAST AUSTRALIA AND NEW ZEALAND D. J. Hunter-smith, N. O'sullivan, C. Bennet, K. Westwood, H. Mccomb and D. Marshall Interplast Australia and New Zealand, Victoria The Lao PDR cleft lip and palate program was started in 1996 when the then Australian ambassador in Lao PDR (Mr Roland Rich) noticed the apparent high prevalence of unrepaired cleft lips and palates within the country. Interplast Australia has since made twelve (12) visits to Lao PDR to train local staff in the techniques of cleft lip and palate repair. This training has resulted in the establishment of a local Laos PDR Cleft team from Mahosot General Hospital (Vientiane) comprising of 2 surgeons, and anaesthetist and a dedicated clinical nurse specialist. The local team is now capable of providing

The Royal Children's Hospital, Melbourne, Victoria New three-dimensional (3D) medical photography at The Royal Children's Hospital (Melbourne), the first in Australia, signifies a major technological advance for routine paediatric photography and healthcare. Dimensionally accurate, non-invasive 3D images are captured in less than two milliseconds providing patient assessment within minutes. Thanks to the digital cameras and super computer processing of the 21st century, creation of the virtual patient is now possible. Provision of a 3D representation of the patient facilitates detailed measurement and analysis so that information specific to each patient case can be generated. These images form part of routine clinical care for patients from the Department of Plastic and Maxillofacial Surgery, with the 3D service now extending into other surgical and non-surgical disciplines of the hospital. As techniques in medicine advance, so too does photography. Description of the setup, image acquisition, outcomes and potential future of the system at The Royal Children's Hospital are discussed. Acknowledgements: This research was funded by grants for the Batten Foundation and the John T Reid Charitable Trust.

Journal compilation © 2008 The Royal Australian and New Zealand College of Surgeons

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