Free paper abstracts numbered 1 -66 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e154–e177 e171 can be raised with or without a skin paddle, although in the latter instance monitoring may be more challenging post- operatively. We present our own practice with scapular flaps and our outcomes and experience with myo-osseous flaps in particular. Materials/Methods: This was a retrospective audit of all patients undergoing vascularized free tissue transfer from the subscapular axis over a 20-year period (1995-2015) at University Hospitals Birmingham. Results/Statistics: A total of 101 cases were identified, of which 61 (60.4%) had case notes available for review. Patients had an average (SD) age of 52.8 (22.4) and male to female ratio of 1.2:1. Reconstruction was performed following ablative oncologic surgery in 50 (82.0%) cases and 47 (77.0%) defects involved a segmental mandibulec- tomy. Scapular/parascapular flaps were the first choice in 57 (93.4%) cases and 28 (45.9%) were raised with no skin pad- dle. Flap failure occurred in 4 (6.6%) patients and this was not found to be more likely in myo-osseus flaps (Fisher’s exact test, p = 0.32). Conclusions/Clinical Relevance: The success rate of scapular/parascapular flaps in our series is comparable to those achieved elsewhere in the literature. Myo-osseous scapular flaps have the combined advantages of better mucosal texture and tension-free primary closure at the donor site, resulting in minimal morbidity and no signif- icant increase in failure rate, although our routine use of implantable Doppler monitoring means that impending fail- ures are identified early. http://dx.doi.org/10.1016/j.bjoms.2016.11.293 48 Technical challenges of adult cleft repair Jennifer Fuller * , Andrew Felstead, Peter Brennan, Serryth Colbert Royal United Hospitals, Bath Introduction/Aims: Speech defects and facial appear- ance due to untreated cleft lip and or palate in the elderly population have associated life-long impacts on the quality of life for these patients. Treatment and rehabilitation in this patient group can be extensive and the problems not easily corrected. We report the outcomes of surgical repair of cleft in a series of elderly patients with unrepaired cleft lip and or palate. Materials/Methods: We report a series adults with unop- erated cleft lip and or palate ranging from ages of 55 to 69. They all reported negative impacts on their quality of life either due to speech difficulties or facial appearance. The management of their cases is presented with a discussion of the impacts and challenges of cleft lip and or palate in the elderly population. Results/Statistics: our results confirm an improvement in speech, quality of life and aesthetic outcomes after surgical repair of cleft in this series. Conclusions/Clinical Relevance: Good outcomes were achieved in this case series, with all patients reporting improvements in their quality of life. With this in mind, we advise the cleft team to consider surgical repair of the untreated cleft lip and or palate in the elderly population. Further research is needed to objectively detect the primary aesthetic needs of elderly patients with cleft lip and or palate http://dx.doi.org/10.1016/j.bjoms.2016.11.294 49 Lip sparing mandibulotomy: a versatile and aesthetic access for cancer surgery and reconstruction Bhavin Visavadia * , Michael Gilhooly Northwick Park Hospital Introduction: Whilst it is routine to access larger and deep seated tumours with jaw splitting procedures, these often breach aesthetic and functional units. We describe access to the oral cavity and pharynx with jaw splitting procedures but with preservation of the lip and oral sphincter. Methods: We present our continuing series of cases of Head and Neck Cancer patients with primary sites ranging from the soft palate to the valleculae of the tongue, which necessitated mandibular access surgery. In all cases, the cer- vical incision was terminated at the Soft Tissue B Point of the lower lip without further lip splitting. All patients were discussed in a Head and Neck Multidisci- plinary Team Clinic and assessments were made of resection margins, accessibility and ease of reconstruction. Results: This presentation will show the versatility of the lip sparing mandibulotomy and the degree of access available whilst maintaining integrity of the lip and chin. We found that this approach did not hinder the mandibular osteotomy, allowed excellent access to the tumour site and preserved both the aesthetic and functional unit of the lip and associated musculature. http://dx.doi.org/10.1016/j.bjoms.2016.11.295 50 Facial Symmetry Index as a measure of Surgical Out- come in complete Unilateral Cleft Lip patients using 3D photographs Ambika Chadha * , Paul Georg, Piet Haers St. Thomas’ Hospital / South Thames Cleft Centre Background & Purpose: Objectifying the 3D outcome of cleft surgery is essential to provide a tool for quality assess- ment that can influence surgical protocols. This requires a reliable and meaningful method of facial analysis. We present a method of facial analysis termed the facial symmetry index