S14 Oral presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S1–S25 the remaining children. Nasal emission improved in 20 cases (80%), remained unchanged in 3, while 2 developed mild degree of nasal emission post-operatively. Overall, 15 (60%) and 23 (92%) had normal or mild degree of hypernasality and nasal emission respectively. Conclusions: This study supports intra-velar veloplasty as a reliable and effective surgical technique for the repair of SMCP resulting in good speech outcome. doi:10.1016/j.bjoms.2011.04.035 35 Pharyngeal reconstruction—is the antero-lateral thigh flap the solution to all potential problems? Z. Al Asaadi * , S. Parmar, T. Martin, C. Jennings, P. Pracy Queen Elizabeth Hospital Birmingham, United Kingdom Introduction: Free jejunal transfer has been used in pha- ryngeal reconstruction for many years. However many have criticised the reconstruction as unreliable, poorly tolerant of radiotherapy and susceptible to stenosis and dysphagia. Recently, there has been a trend to use the antero-lateral thigh flap for pharyngeal reconstruction to overcome these prob- lems. Many authors have described positive results with the use of the ALT for pharyngeal defects. Aims: We at the University Hospital Birmingham have used the jejunal free flap for pharyngeal reconstruction for many years. In view of recent literature we changed to use the ALT flap. Materials and methods: We carried out a retrospective analysis of all patients who underwent pharyngeal recon- struction with an ALT flap in our unit since changing from a jejunal flap. Only circumferential defects were included in the study. Results: 6 patients underwent pharyngeal resection and required reconstruction of a circumferential defect between 2007 and 2010. All these defects were reconstructed with a tubed antero-lateral thigh flap. There were no flap failures or partial necrosis. However, the leak rate was unacceptably high. Stricturing still occurred and many patients’ diet was still restricted. 2 patients required the ALT to be replaced with a jejunal free flap. Conclusions: Although there were no flap failures in our series, we have been unable to replicate the results of other surgeons and have had to abandon the use of the ALT for the reconstruction of circumferential pharyngeal defects. We have returned to use the jejunal free flap. doi:10.1016/j.bjoms.2011.04.036 36 Maxillofacial ballistic injuries in the Surgical Specialties Hospital in Baghdad, Iraq, 2006–2009 A. Al-Rikabi * , M. Alshalah, T.J. Havard Royal Glamorgan Hospital, Llantrisant, United Kingdom Aim: Ballistic injuries to the head and neck constitute an important type of injuries during conflicts. Maxillofacial sur- geons in troubled parts of the world, like Iraq, deal with a high caseload of complex trauma caused by conflict. Our aim is to share our extensive experience in the management of these challenging cases; we will describe some important lessons learned and include some interesting clinical observations. Methods: We used a single maxillofacial surgeon’s the- atre logbook for the period from 2006 to 2009, in the Surgical Specialties Hospital in Baghdad, Iraq. Results: 276 patients were operated on for a maxillofa- cial injury from 2006 to 2009. Shell injuries accounted for 143, blast 77 and 56 bullet injuries. The ages of the injured ranged from 2 years to 74 years old. Men accounted for 232 of the cases and women 44. Mandibular injuries occurred in 182 patients. The surgical techniques used included k-wiring, suturing and external fixation or bone grafting with plating. Clinical relevance: Maxillofacial injuries sustained in conflict can be devastating with immediate risk to life and the potential for long-term functional and cosmetic conse- quences. We will present the clinical lessons gained through considerable recent experience of injuries caused by modern warfare. doi:10.1016/j.bjoms.2011.04.037 37 Biomechanical study of the effectiveness of unilocking T-plate systems for prophylactic internal fixation of the radial osteocutaneous donor site C. Avery * , M. Skidmore, A. Peden University of Leicester, Mexico Introduction: Prophylactic internal fixation (PIF), with a bone plate in either the anterior (over the section defect) or posterior (on intact cortex) position, has substantially reduced the incidence of fracture at the donor site of the radial osteo- cutaneous free flap. This study uses the sheep tibia model to compare the effectiveness of new T-shaped titanium plates utilising a unilocking screw system with a 3.5 mm steel plate and bicortical screw fixation system commonly applied for PIF. Methods and results: 40 matched pairs of adult sheep tibias were tested in torsion and 4-point bending. An osteotomised bone was significantly weaker (p < 0.001) than an intact bone in both bending and torsion with a mean loss of 77% and 64% of strength respectively. All constructs significantly strengthened an osteotomised bone by a fac-