Structural and actual distraction discrepancy following monobloc distraction in syndromic craniosynostosis

61 stereophotogrammetry — it records 60 3D images of the face/second. Facial expression that takes 3 seconds, generates 180 3D images. Landmarks are automatically tracked throughout the sequence of the images. Objectives: Evaluate the reproducibility of the dynamics of facial expressions and the clinical applications of 4D imaging for the analysis of facial muscle movements in asymmetric mandibular deformities, facial paralysis and following cleft repair. Methods: The method was validated by capturing facial expressions of 32 non-patient volunteers, 20 cases of unilateral facial paralysis, 20 unilateral cleft lip and palate (UCLP) patients and 23 orthognathic cases. Four facial expressions were captured. The reproducibility of facial movements was evaluated, the asymmetry of facial expressions was measured in each group of cases and the improvements of the symmetry of facial muscle movements following orthognathic surgery were assessed. Results: The accuracy of the automatic tracking of facial landmarks was within 0.55 mm maximum smile was the most reproducible expression in non-patient volunteers and the least reproducible in facial paralysis. The orthognathic correction of facial asymmetry improved the balance of facial muscle movements. The method identified residual distortion of facial expressions following the surgical repair of UCLP. Conclusions: 4D facial imaging is a reliable method for recording facial expressions; the method facilitates the analysis of facial muscle movements and a useful tool for outcome measures of the surgical correction of orofacial deformities. http://dx.doi.org/10.1016/j.ijom.2017.02.222 The clinical application of bone morphogenetic protein for reconstruction of alveolar cleft A. Ayoub ∗ , C. Roshan, T. Gillgrass, K. Naudi University of Glasgow, United Kingdom Background: Autogenous bone graft is the gold standard for the reconstruction of alveolar cleft; however, harvesting the graft is associated with well-documented morbidities.1 Bone morphogenetic proteins (BMPs) proved successful in inducing bone formation in preclinical model and in limited clinical investigations. Objectives: Assess the clinical feasibility and the success rate of reconstructing the alveolar defect using recombinant human BMP-7 (rhBMP-7). Methods: This phase II clinical trial was carried out on 11 consecutive cases, 3.5 mg of rhBMP-7 (Osigraft OP1) on a type I collagen carrier was applied for the reconstruction of alveolar cleft in children of an average age of 10 years. In addition to the clinical evaluation, radiographic assessment was carried out to evaluate bone formation and evaluate the eruption of the impacted teeth. Patients were followed up for an average of seven years. Findings: Postoperative complications were minimal, none of the cases developed infection that required further intervention. The stay in the hospital was limited to one day. Normal trabecular bony pattern was detected, 90% of the cases scored grade I on the Kindelan four-point scale. Teeth erupted through the newly formed bone. No bone formation was noted outside the alveolar defect. Conclusion: rhBMP-7 was radiographically and clinically successful in regenerating bone at the alveolar cleft site. This

shortened the operating time, facilitated recovery and eliminated the morbidities associated with autogenous bone graft.

Reference 1. Swan, M. C., & Goodacre, T. E. (2006). Morbidity at the iliac crest donor site following bone grafting of the cleft alveolus. Br J Oral Maxillofac Surg, 44, 129–133.

http://dx.doi.org/10.1016/j.ijom.2017.02.223 Structural and actual distraction discrepancy following monobloc distraction in syndromic craniosynostosis M.N. Azmi ∗ , F. Hariri University of Malaya, Kuala Lumpur, Malaysia Background: Monobloc distraction osteogenesis (DO) can be indicated as an alternative surgery in severe syndromic craniosynostosis as it allows superior segmental advancement as compared to conventional technique. Objectives: The aim of our study is to assess the discrepancy between the total distraction amount achieved from the distractor device and the actual segmental movements amongst five paediatric patients (aged eight months to six years) with Crouzon syndrome. Methods: All patients were identified to have functional issues namely increased intracranial pressure, inability for eyelid closure due to severe exorbitism and obstructive sleep apnoea secondary to narrow nasopharyngeal airway thus indicating surgical procedure of monobloc DO. Pre- and postsurgical computed tomography (CT) scan data and three-dimensional (3D) biomodel for each patient were obtained. Pre- and postsurgical clinical and functional outcomes were also documented. Measurement of anatomical and reference points from five sets of pre- and postsurgical 3D biomodel and CT images were performed and analysed statistically. Findings: Based on Wilcoxon Signed Rank Test, significant discrepancies (P 0.05). Favourable results in all clinical and functional outcomes were demonstrated in four out of five patients. Conclusion: Monobloc DO provides reliable alternative in addressing important functional issues presented in severe syndromic craniosynostosis patients but our study demonstrated that discrepancy of actual structural and device advancement should be anticipated thus needing overcorrection for consideration. http://dx.doi.org/10.1016/j.ijom.2017.02.224 Individualised surgical management of unilateral cleft lip repair S. Bing State Key Laboratory of Oral Disease, West China College of Stomatology, Sichuan University, China Many different techniques were employed for unilateral cleft lip repair since the 1800s; even some classical techniques were developed. However, most techniques could not always get good outcomes in all types of cleft lips because of the application limit. In order to get stable surgical outcomes of unilateral cleft lip, we developed three individualised surgical techniques for microform cleft lip, incomplete cleft lip and complete cleft lip according to the cleft characters of different unilateral cleft lip separately. The