Department of Plastic and Maxillofacial Surgery by yungtyriq


									Department of Plastic
and Maxillofacial Surgery
Annual Report 2003/04
Table of Contents

EXECUTIVE SUMMARY                                                           2
  Clinical                                                                   2
  Research                                                                   2
  Education                                                                  2
THE YEAR IN REVIEW                                                           3
  Highlights                                                                 3
  New Initiatives                                                            5
  Staff Achievements                                                         6
CLINICAL OPERATIONS                                                          7
  Organization Chart                                                         7
  Theatre                                                                    8
  Outpatient Clinics                                                         8
RESEARCH OPERATIONS                                                         10
  Projects                                                                  10
  Grants                                                                    12
  Publications                                                              13

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04   1
Executive Summary


As a result of strong support from the hospital Executive, as well as the investment in resources and
personnel that The Royal Children’s Hospital made in the Department of Plastic and Maxillofacial
Surgery, the 2003/2004 fiscal year was a time of tremendous growth and change. Our clinical volume
increased by 40% over the 5 year average prior to 2003. In outpatients as well, both the volume and
efficiency improved dramatically. Prior to 2003 the outpatient waiting time to first appointment was 6
months for a general paediatric plastic surgical referral; it is now 1 week. This occurred during a year
with a 19% increase in outpatient volume.


Dr Peter Farlie, our first Deputy Director (Research), has only been in this position for 18 months and
his leadership and initiatives are already beginning to pay “dividends”. We now have 6 major
research themes that truly span from “bench-top to bedside”. There were 10 successful grant
submissions, including an NHMRC project grant studying the molecular control of mandibular
development won by Dr Farlie. In addition, Dr Farlie was instrumental in securing corporate
sponsorship for our new tissue engineering project which will begin in January 2005.


In August 2003 the Department sponsored a multidisciplinary cleft conference which highlighted three
internationally renowned cleft experts in speech pathology, psychology and cleft surgery. This was an
exciting conference that helped to promote the multidisciplinary team care provided here at RCH.

In addition we began a visiting professor program. John Reinisch, from Childrens Hospital Los
Angeles was our first visiting professor. Dr. Reinisch is the world expert in Medpor ear reconstruction
for microtia.

In terms of registrar education; our Department, in collaboration with the Department of Dermatology,
began a registrar “exchange” program allowing the registrars from both specialties to gain experience
and exposure to each others’ specialties and work with each others’ consultants directly.

In the area of consumer education, we have been fortunate to receive funding from the Mark and
Chapter Freemasons of Victoria for production of parent information booklets. These booklets, highly
praised by parents, were produced by our Educational Resource Centre.

Within the RCH, for our own employees, a new initiative began to increase the information exchange
between our Department and the rest of the RCH community. A monthly lecture series was begun,
which is a series of rotating lectures given by our Department to different wards in the hospital to
educate our colleagues about plastic and maxillofacial surgery as well as promote collaboration and

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                              2
The Year in Review


3D Camera – Donation from the Muriel and Les Batten Foundation

                                                           The Department received a very generous
                                                           donation from the Muriel and Les Batten
                                                           Foundation which enabled the purchase of a 3-
                                                           dimensional digital imaging system. It is the
                                                           first of its kind installed in Australasia and the
                                                           benefits of this technology will aid many
                                                           departments in the hospital with pre-operative
                                                           patient treatment planning, post-operative
                                                           assessment and outcomes research.

Visiting Professor

Dr. John Reinisch, Chief of Plastic Surgery at
Childrens Hospital Los Angeles was our visiting
professor this past year. Dr. Reinisch has been a
pioneer in reconstruction of the ear deformity,
microtia, using an alloplastic material called Medpor
and is an internationally recognized expert using this
technique. Dr. Reinisch worked with our trainees and
consultants in the operating theatre and gave several
lectures on the topic of ear reconstruction.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                                   3
Cleft Symposium

                                        In August 2003 the Department conducted an intensive
                                        educational program in cleft management. The program focused
                                        on the holistic management of individuals born with a cleft of
                                        the lip/palate from birth to adulthood, including issues related to
                                        diagnosis, feeding, surgery, speech, oral health and orthodontics.
                                        Key note speakers included highly respected international
                                        clinicians from this field including Mr Brian Sommerlad,
                                        Consultant Plastic Surgeon and Dr Debbie Sell, Head of Speech
                                        and Language Therapy, both from Great Ormond Street Hospital
                                        for Children, London. The meeting also hosted Professor
                                        Nichola Rumsey, Professor of Appearance and Health
                                        Psychology and Research Director from the Centre for
                                        Appearance Research at the University of the West of England.

National Australia Bank Support

The Channel & Process Optimisation Division at
The National’s head office in Melbourne has
generously donated to the Department.           This
donation is part of the National’s Community
Donation program designed to allow each outlet or
division within the National to choose a community
based initiative to assist. The Department plans to
allocate the donation to assist patients and families
who travel from country Victoria and Tasmania with
the many out of pocket costs associated with their
trip to the hospital.

                                                             Dennis Pozzobon, Head of Distribution of
                                                             Channel & Process Optimisation, presents the
                                                             cheque to John Meara

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                                 4

Multidisciplinary Microtia clinic

The Microtia Clinic was developed by the Department in conjunction with the Department of
Otolaryngology. This specialist clinic enables a combined approach to treating patients with Microtia
and other complex ear abnormalities.

Enhanced Registrar Training

The Department has begun an educational “exchange” program with the Department of Dermatology
to assist in the training of both specialties’ trainees. This enables the dermatology trainees to attend
plastic surgery theatre lists, working with one of the plastic surgery consultants, to learn basic suturing
techniques and wound management. At the same time, the plastic surgery registrars are spending time
in the Dermatology Laser Clinic to learn about this treatment modality.

Parent Information Booklets

The ongoing relationship between the Department and Mark and Chapter
Freemasons of Victoria has continued this year. We received a number
of very generous donations from the Freemasons for the printing of three
new parent information booklets – “Understanding Brachial Plexus
                             Palsy”, “Craniofacial Surgery Information”
                             and “Cleft Lip & Palate – Questions and
                             Answers.” These booklets were designed to
                             provide patients and parents with
                             information that enhances their knowledge
                             of these diagnoses and promotes better
                             communication with clinicians.

Transition of Adult Patients

In February this year, a collaborative venture was formed with the Plastic Surgery Department at
Royal Melbourne Hospital to provide adolescent and adult burns, cleft or craniofacial patients with
age-appropriate care and treatment. This process involves transferring adult RCH patients to Royal
Melbourne Hospital for evaluation and ongoing treatment in the newly established “Transition Clinic”.

New Department Website

The Department redeveloped its website recently, significantly increasing the traffic and “hits” on its
site at Information now appearing online includes a list of department
sections and the specialty clinics in each section, parent information such as post surgery instructions,
an overview of current research projects, information on training opportunities, and a detailed profile
of each Department staff member.

Medical Student Education

A regular Wednesday morning tutorial has been developed for medical students during their two week
rotation through Paediatric Surgery and the Emergency Department. This program is being expanded
to include topics presented by a number of consultants and registrars.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                                 5

Peter Farlie was awarded two research grants. The first was a three year research grant from the
National Health and Medical Research Council, and the second was from the Smile Train organization
in the United States for research into craniofacial anomalies. These research grants will be used to
investigate the genes that cause Pierre Robin Sequence which results in a small jaw and cleft palate.
The project aims to identify the genes that cause this condition and the exact mechanism of the genetic
defect. Identifying the genetic cause of this condition may lead to better treatment options for children
in the future.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                               6
Clinical Operations

                                                    John Meara

                   Tanya Armstrong
                                                  Bruce Johnstone                      Peter Farlie
                      Marion Batt
                                                  Deputy Director,                   Deputy Director,
                    Gayle Morison
                                                 Clinical Operations                    Research
                   Gianna La Rocca

                                                    Hand and
        Cleft and             General Plastic                                 Oral and
                                                   Microvascular                                        Research
   Craniofacial Surgery          Surgery                                Maxillofacial Surgery

     Anthony Holmes            Kirstie MacGill     Chris Coombs           Andrew Heggie           Andrea Bialocerkowski
      (Section Chief)          (Section Chief)     (Section Chief)        (Section Chief)           Annette Da Costa
                                                                                                       Tam Dieu
    Heather Cleland            Alan Breidahl      Bruce Johnstone        John Ferguson*             Michael Hubbard*
   Marcelle McLaughlin      Andrew Greensmith     David McCombe         Stephen Gibbons*            Ravi Savarirayan*
     (Co-ordinator)           Keith Mutimer*        Hand Fellow            Tim Probert
      John Meara            Anthony Penington                             Jocelyn Shand
   Craniofacial Fellow
  * Honorary

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                                              7

The surgical volume in the Department has increased dramatically over the last 18 months. The
Department now runs 50 theatre sessions per month and our surgeons operated on 40% more patients
than the 5 year average prior to 2003.


There was also a large increase in the number of outpatient clinics and the number of patients seen this
year. The Department now runs 65 outpatient clinics per month and saw 19% more patients than in
the 2002/03 financial year.

Specialty clinics:

    The Burn Clinic is run by a multidisciplinary team of general surgeons, plastic surgeons and hand
    therapists. The clinic provides care for severely burnt children including overall patient
    management and acute excision and skin grafting by general surgeons and specialist acute care for
    children with burnt hands, faces and electrical burns by plastic surgeons.

    Cleft Lip and Palate
    The Cleft Lip and Palate Clinic has a large and experienced group of specialists - plastic surgeons,
    oral and maxillofacial surgeons, ENT (Ear, Nose and Throat) surgeons, audiologists,
    paedodontists, orthodontists, otolaryngologists, speech pathologists, social workers and nurses.

    The Craniofacial Clinic provides complete care and treatment for children with all types of
    craniofacial disorders. This includes children with birth defects, deformity following trauma, or
    craniofacial growth disorders. Our team consists of plastic surgeons, dentists, ophthalmologists,
    anaesthetists, geneticists, orthodontists, photographers, orthotists (helmet remodelling),
    psychiatrists, social workers and specially trained nursing staff, both in theatre and the wards.

    General Paediatric Plastic Surgery
    The General Paediatric Plastic Surgery clinics provide expertise in the treatment of common
    congenital hand anomalies, vascular birthmarks and malformations, paediatric burns, microsurgery
    and general paediatric plastic surgical problems.

    The Hand Clinic has evolved to meet the needs of children with a wide range of upper limb
    disorders including congenital anomalies, injuries, burns and neurological conditions such as
    brachial plexus injuries and cerebral palsy. The clinic is staffed by plastic surgeons, orthopaedic
    surgeons, occupational therapists, physiotherapists, orthotists and nursing staff all trained in the
    care of children with congenital and acquired conditions of the upper limb.

    The Microtia Clinic is a new clinic developed by the Department of Plastic & Maxillofacial
    Surgery and the Department of Otolaryngology. This specialist clinic enables a combined
    approach to treating patients with Microtia and other complex ear abnormalities. This clinic is
    staffed by plastic surgeons, ENT surgeons, audiologists and a nursing coordinator.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                              8
    Obstetric Brachial Plexus Palsy
    The Obstetric Brachial Plexus Palsy Clinic is run by a multi-disciplinary team of plastic surgeons,
    orthopaedic surgeons, physiotherapists and occupational therapists. A brachial plexus injury
    occurs during childbirth if the baby’s shoulders unexpectedly become trapped in the mother’s pelvis
    leading to the unavoidable stretching of the brachial plexus. Children in this clinic are seen by a
    physiotherapist on a monthly basis and regularly by the surgeons throughout the first year of
    life. Many require complex reconstruction involving nerve grafts and later tendon, joint and bone

    Oral and Maxillofacial
    The Oral and Maxillofacial Clinic is staffed by a team of oral and maxillofacial surgeons,
    orthodontists and paedodontists. The clinic cares for children with a wide range of dental, jaw and
    facial disorders resulting from congenital anomalies, trauma, growth disorders or tumours.

    Salivary Control
    This multidisciplinary clinic is staffed by a paediatrician, plastic surgeon, dentist, speech
    pathologist and a clinic co-ordinator/research nurse. Treatment options include a range of
    interventions and for some patients surgery may be required. The most common procedure for the
    control of drooling involves rerouting the ducts of the submandibular salivary.

    Vascular Anomalies
    The Vascular Anomalies Clinic is headed by Anthony Penington and specialises in the treatment
    of infants and children with vascular lesions. Hemangiomas and vascular malformations are
    extremely common and can be difficult to diagnose properly if not familiar with these lesions. The
    clinic provides the expertise to properly diagnose and recommend treatment and/or intervention
    for these lesions.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                              9
Research Operations

Bone tissue engineering
The repair of congenital or acquired defects in the secondary palate and cranial bones remains a
significant clinical challenge. The availability of reliable, widely applicable biomaterials to augment
the range of surgical approaches utilized in the repair of palate and calvarial defects would greatly
enhance management of these conditions. In collaboration with the Department of Chemical and
Biomolecular Engineering, University of Melbourne, we are developing a research program with a
focus on the application of existing biomaterials and the development of novel modifications. These
materials will facilitate enhanced biointegration and the use of patient derived chondrogenic and
osteogenic precursors for tissue engineering.

Gene identification for Pierre Robin Sequence
Pierre Robin Sequence is a condition involving mandibular hypoplasia, cleft palate and glossoptosis.
Children affected with this condition frequently have respiratory and feeding difficulties neonatally
which result in moderate to severe growth and development deficiencies in the first year of life. Pierre
Robin Sequence occurs in conjunction with a number of syndromes but also exists in an isolated form.
Isolated Pierre Robin Sequence occurs as a sporadic condition but can also be inherited as an
autosomal dominant trait. We are using molecular genetics approaches to identify the gene responsible
for isolated Pierre Robin Sequence in an Australian family with a translocation between chromosomes
2 and 17. We have recently identified a novel gene at the breakpoint on chromosome 17 and are
characterizing the nature and significance of this genetic lesion in the aetiology of isolated Pierre
Robin Sequence by screening for mutations to this gene in unrelated Pierre Robin Sequence patients.
In addition, recent advances in our understanding of this gene are leading to the development of
animal models that will enable us to investigate the developmental sequence leading to Pierre Robin

Craniofacial Development: characterising the molecular regulators
Many congenital anomalies of the craniofacial complex derive from alterations to the normal
developmental program that occurs during the first trimester. Animal models can be used to determine
the cellular and molecular basis of this early development. We are using avian and mouse models to
identify key regulatory molecules that determine cell behaviour and differentiation during the earliest
phases of craniofacial development. There are a number of cell types involved in development of the
craniofacial complex but our focus is on the neural crest cells that form much of the skeletal elements
of the head and face. Recent developments in this area include identification of the transcription factor
Sox10 as a key regulator of neural crest cell development and the involvement of another transcription
factor known as Dlx2 in regulating the earliest stages of skeletogenesis.

Neuropsychological characteristics of children with craniofacial anomalies
The long-term cognitive outcomes in craniofacial conditions are poorly described, and few
experimental studies have characterised the wide spectrum of neuropsychological abilities of this
population beyond global intellect. A preliminary pilot study that was conducted in 2002 described
the neuropsychological profiles of 34 children with SC (n=13) and NSC (n=21) who had undergone
cranial expansion surgery using standardised measures of intellectual, attention, memory, academic
achievement, executive and social and emotional functioning. Amongst the study's major findings, it
was identified that the syndromic craniosynostoses were associated with better cognitive outcomes
than reported in the early literature. However study findings also showed that children with NSC, a
condition that has been associated with relatively benign cognitive sequelae, displayed subtle
neuropsychological deficits in attention and executive skills. Current and future research is aimed at
building upon these preliminary findings through longitudinal studies that will evaluate the
neuropsychological abilities of individuals with craniosynostosis from birth to adolescence at key
points in their developmental trajectories.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                              10
Obstetric Brachial Plexus Palsy
In collaboration with the Department of Pathology, the microcopic appearance of the cross-sections of
nerves prepared for nerve grafting in obstetrical brachial plexus injury are now being graded according
to a system developed by Dr C.W.Chow. This is being correlated with the operative appearance of the
resected nerve stumps and will be trialed as an intra-operative frozen section technique, similar to the
method used at the Sick Children's Hospital in Toronto. We are planning increased collaboration with
the Toronto group and hope to start long-term studies comparing the histological grading with the
clinical outcome.

Another research project in obstetric brachial plexus palsy was commenced in late 2003 by Dr Andrea
Bialocerkowski (Lecturer, School of Physiotherapy, The University of Melbourne, NHMRC Research
Fellow). This research focuses on developing appropriate, valid, reliable and sensitive methods of
tracking changes in movement of child's upper limb. The results of this research will assist in the
selection and evaluation of appropriate management strategies for these children.

Dr Tam Dieu is studying the early embryology of the chick brachial plexus and its stereotypical
pattern. This system is then used as a model for future studies in axonal guidance and path finding – in
particular, the role of Semaphorin3A and Semaphorin3D (axonal guidance cues) in this process. A
better understanding of the normal developmental process of the brachial plexus may have significant
implications for the management of brachial plexus palsy.

Craniofacial Sciences Consortium Cleft Registry
Research into the aetiology and treatment of facial clefts is a major focus of the Craniofacial Sciences
Consortium, MCRI, a key research partner of the Department of Plastic and Maxillofacial Surgery. A
registry containing data on the family history, nature, treatment and management of clefts was
established 3 years ago by the CFSC and recent joint funding has enabled the appointment of a Cleft
registry research coordinator. The purpose of the registry is to enable identification of trends in
treatment and outcomes in cleft patients, better define the cleft population and identify phenotypic
sub-groups that will facilitate research into the aetiology of facial clefts and inform best practice. The
appointment of a research coordinator will greatly increase cleft research outcomes from a number of
ongoing research projects including investigation of feeding issues in children with clefts and
identification of key indicators of positive outcomes in cleft conditions.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                               11

Peter Farlie
    1. NH&MRC project grant 237134, Biological and Mathematical studies of development of the
       enteric nervous system; ($370,000) - D.F. Newgreen, K. Landman, P.G. Farlie
    2. MRUFD grant in aid, Molecular phenotyping in cranial neural crest cells-a pilot application of
       microsample proteomics analysis ($10,000) - PG Farlie, M Hubbard
    3. Smile Train/Plastic Surgery Education Fund grant in aid, Identifying a gene for isolated Pierre
       Robin Sequence (US$19,500) - PG Farlie, Jamshidi, Thomas and Kilpatrick
    4. NH&MRC project grant 284522, Molecular control of mandibular development, ($345,000) -
       PG Farlie and Newgreen

Andrea Bialocerkowski
   1. Melbourne University Early Career Researcher Grant " Reliability of two outcome measures
      for obstetric brachial plexus palsy"
   2. Joanna Briggs Institute Systematic Review Grant "The effectiveness of conservative
      management for the management of children (under the age of 2 years) diagnosed with
      obstetric brachial plexus palsy
   3. Ian Potter Foundation Travel Grant
   4. CASS Foundation Travel Grant
   5. Allied health and Nursing See Grants, Royal Children's hospital (Positional plagiocephaly: a
      systematic review of the prevalence, risk factors and natural; history)
   6. Research grant, School of Physiotherapy, The University of Melbourne (Obstetric brachial
      plexus palsy: pilot study of movement patterns in children over the age of 4 years)

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                           12

Andrea Bialocerkowski
   1. Bialocerkowski, A., Grimmer, K.A. Measurement of isometric wrist muscle strength--a
      systematic review of starting position and test protocol. Clin Rehabil. 2003 Nov;17(7):693-
   2. Bialocerkowski, A.E., Grimmer, K.A., Bain, G.I. Validity of the patient-focused wrist
      outcome instrument: do impairments represent functional ability? Hand Clin. 2003
      Aug;19(3):449-55, ix.
   3. Bialocerkowski, A.E., Grimmer, K.A., Bain, G.I. Development of a patient-focused wrist
      outcome instrument. Hand Clin. 2003 Aug;19(3):437-48, ix.

Heather Cleland
   1. Leung, M.K., Dieu, T., Cleland, H., Surgical approach to the accessory nerve in the posterior
       triangle of the neck Plast Reconstr Surg. 2004 Jun;113(7):2067-70.
   2. Dieu, T., Leung, M., Leong, J., Morrison, W., Cleland, H., Archer, B., Oppy, A., Too Much
       Vacuum-Assisted Closure Aust.N.Z. J. Surg. Vol. 73, No. 12, 1057, 2003.

Chris Coombs
   1. De Paoli A.G., Dargaville P.A., O'Donnell C.P., Casalaz D.M., Taylor R.G., Coombs C.J.,
       Morley C.J. Embolization of cannula fragments during insertion of central catheters. J
       Pediatr. 2003 Nov; 143(5): 690-1.
   2. Johnstone, B.R., Richardson, P.W., Coombs, C.J., Duncan, J.A. Functional and cosmetic
       outcome of surgery for cerebral palsy in the upper limb. Hand Clin. 2003 Nov; 19(4): 679-86.

Tam Dieu
   1. Leung, M.K., Dieu, T., Cleland, H., Surgical approach to the accessory nerve in the posterior
      triangle of the neck Plast Reconstr Surg. 2004 Jun;113(7):2067-70.
   2. Dieu, T., Leung, M., Leong, J., Morrison, W., Cleland, H., Archer, B., Oppy, A., Too Much
      Vacuum-Assisted Closure Aust.N.Z. J. Surg. Vol. 73, No. 12, 1057, 2003.

Peter Farlie
    1. Farlie, P.G., McKeown, S.J., Newgreen, D.F. The neural crest: basic biology and clinical
       relationships in the craniofacial and enteric nervous systems. Birth Defects Res Part C Embryo
       Today. 2004 Jun;72(2):173-89.
    2. Jamshidi, N., Macciocca, I., Dargaville, P.A., Thomas, P., Kilpatrick, N., McKinlay, Gardner,
       R.J., Farlie, P.G. Isolated Robin sequence associated with a balanced t(2;17) chromosomal
       translocation. J Med Genet. 2004 Jan;41(1):e1.
    3. Bates, D., Taylor, G.I., Minichiello, J., Farlie, P.G., Cichowitz, A., Watson, N.F., Klagsbrun,
       M., Mamluk, R., Newgreen, D.F. (2003) Neurovascular congruence results from a shared
       patterning mechanism that utilizes Semaphorin3A. Dev Biol 255, 77-98
    4. McKeown, S.J., Newgreen, D.F., Farlie, P.G. (2003) Temporal restriction of migratory and
       lineage potential in rhombomere 1 and 2 neural crest. Dev Biol 255, 62-76

Andrew Heggie
   1. Chigurupati, R., Massie, J., Dargaville, P., Heggie, A.A. Internal mandibular distraction to
      relieve airway obstruction in infants and young children with micrognathia. Pediatr Pulmonol.
      2004 Mar 37(3):230-5.
   2. Lynham, A.J., Chapman, P.J., Monsour, F.N., Snape, L., Courtney, D.J., Heggie, A.A., Jones,
      R.H., McKellar, G.M. Management of isolated orbital floor blow-out fractures: a survey of
      Australian and New Zealand oral and maxillofacial surgeons. Clin Experiment Ophthalmol.
      2004 Feb;32(1):42-5.
   3. Arpornmaeklong, P., Shand, J.M., Heggie, A.A., Stability of combined Le Fort I maxillary
      advancement and mandibular reduction. Aust Ortho J Nov 2003;19:57-66.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                           13
    4. Heggie, A.A., Shand, J.M., Aldred, M.J., Talacko, A.A., Juvenile mandibular chronic
       osteomyelitis: a distinct clinical entity. Int. J Oral Maxillofac Surg Oct 2003;32:459-468

Michael Hubbard
   1. Hubbard, M.J., Mangum, J.E., McHugh, N.J. Purification and biochemical characterization
      of native ERp29 from rat liver Biochem. J. (2004) 383, 1–9

Bruce Johnstone
   1. Johnstone, B.R., Richardson, P.W.F., Coombs, C.J. Duncan, J.A. Functional and Cosmetic
       Outcome of Surgery for Cerebral Palsy in the Upper Limb. Hand Clin 2003 Nov;19(4):679-

Kirstie MacGill
   1. Rosen, H., Barrios, L.M., Reinisch, J.F., MacGill, K., Meara, J.G. Outpatient cleft lip repair.
        Plast Reconstr Surg. 2003 Aug;112(2):381-7; discussion 388-9.

John Meara
   1. Reinisch, J.F., Kim, R.Y., Harshbarger, R.J., Meara, J.G. Surgical management of parotid
      hemangioma Plast Reconstr Surg. 2004 Jun;113(7):1940-8.
   2. Pirouzmanesh, A., Reinisch, J.F., Gonzalez-Gomez, I., Smith, E.M., Meara, J.G.
      Pilomatrixoma: a review of 336 cases. Plast Reconstr Surg. 2003 Dec; 112(7):1784-9.
   3. Meara, J.G., Burvin, R., Bartlett, R.A., Mulliken, J.B. Anthropometric study of synostotic
      frontal plagiocephaly: Before and after fronto-orbital advancement with correction of nasal
      angulation. Plast Reconstr Surg. 2003 Sept. 112(3): 731-739.
   4. Chang, S.W., Plotkin, D., Mah, J., Polido, J., Meara, J.G., Teledentistry in Rural California:
      A USC Initiative CDA Journal. 2003 Aug.Vol.31.No.8: 601-608.
   5. Rosen, H., Barrios, L.M., Reinisch, J.F., MacGill, K., Meara, J.G. Outpatient cleft lip repair.
      Plast Reconstr Surg. 2003 Aug;112(2):381-7; discussion 388-9.

Anthony Penington
   1. Dolderer, J.H., Kelly, J.L., Morrison, W.A., Penington, A.J. Foreign-body retrieval using a
      rare earth magnet. Plast Reconstr Surg. 2004 May;113(6):1869-70.
   2. Cronin, K.J., Messina, A., Knight, K.R., Cooper-White, J.J., Stevens, G.W., Penington, A.J.,
      Morrison, W.A. New murine model of spontaneous autologous tissue engineering, combining
      an arteriovenous pedicle with matrix materials. Plast Reconstr Surg. 2004 Jan;113(1):260-9.

Ravi Savarirayan
   1. White, S.M., Thompson, E.M., Kidd, A., Savarirayan, R., Turner, A., Amor, D., Delatycki,
       M.B., Fahey, M., Baxendale, A., White, S., Haan, E., Gibson, K., Halliday, J.L., Bankier, A.
       Growth, behavior, and clinical findings in 27 patients with Kabuki (Niikawa-Kuroki)
       syndrome Am J Med Genet. 2004 Jun 1;127A(2):118-27.
   2. Aldred, M.J., Talacko, A.A., Savarirayan, R. Jaw lesions and hyperparathyroidism J Oral
       Maxillofac Surg. 2004 Apr;62(4):519.
   3. Bateman, J.F., Freddi, S., McNeil, R., Thompson, E., Hermanns, P., Savarirayan, R.,
       Lamande, S.R. Identification of four novel COL10A1 missense mutations in schmid
       metaphyseal chondrodysplasia: further evidence that collagen X NC1 mutations impair trimer
       assembly Hum Mutat. 2004 Apr;23(4):396.
   4. Aldred, M.J., Talacko, A.A., Savarirayan, R. Ossifying fibroma of the face and
       hyperparathyroidism in a chronic hemodialysis patient. Nephrologie. 2004;25(1):33
   5. Pedreira, C.C., Savarirayan, R., Zacharin, M.R. IMAGe syndrome: a complex disorder
       affecting growth, adrenal and gonadal function, and skeletal development J Pediatr. 2004
   6. Savarirayan, R., Boyle, R.J., Masel, J., Rogers, J.G., Sheffield, L.J. Long term follow-up in
       chondrodysplasia punctata, tibia-metacarpal type, demonstrating natural history. Am J Med
       Genet. 2004 Jan 15;124A(2):148-57

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                          14
    7. Janssens, K., Thompson, E., Vanhoenacker, F., Savarirayan, R., Morris, L., Dobbie, A., Van
        Hul, W. Macrocephaly and sclerosis of the tubular bones in an isolated patient: a mild case of
        craniodiaphyseal dysplasia? Clin Dysmorphol. 2003 Oct;12(4):245-50
    8. James, P.A., Shaw, J., du Sart, D., Craig, E., Bateman, J.F., Savarirayan, R. Molecular
        diagnosis in a pregnancy at risk for both spondyloepiphyseal dysplasia congenita and
        achondroplasia. Prenat Diagn. 2003 Oct;23(10):861-3.
    9. Makitie, O., Savarirayan, R., Bonafe, L., Robertson, S., Susic, M., Superti-Furga, A., Cole,
        W.G. Autosomal recessive multiple epiphyseal dysplasia with homozygosity for C653S in the
        DTDST gene: double-layer patella as a reliable sign. Am J Med Genet. 2003 Oct 15; 122A(3):
    10. Hill, V., Sahhar, M., Aitken, M., Savarirayan, R., Metcalfe, S. Experiences at the time of
        diagnosis of parents who have a child with a bone dysplasia resulting in short stature. Am J
        Med Genet. 2003 Oct 1;122A(2):100-7.
    11. Savarirayan, R., Thompson, E., Gecz, J. Spondyloepiphyseal dysplasia tarda (SEDL, MIM
        #313400). Eur J Hum Genet. 2003 Sep;11(9):639-42.

Jocelyn Shand
   1. Shand, J.M., Beatty, R.L., Tankersley, K.L., Costello, B.J. Mitek anchors in facial injury: an
       approach for soft tissue flap fixation. J Oral Maxillofac Surg. 2004 May;62(5):619-21.
   2. Shand, J.M., Albrecht, R.M., Burnett, H.F. 3rd, Miyake, A. Invasive fungal infection of the
       midfacial and orbital complex due to Scedosporium apiospermum and mucormycosis. J Oral
       Maxillofac Surg. 2004 Feb;62(2):231-4.
   3. Heggie, A.A., Shand, J.M., Aldred, M.J., Talacko, A.A., Juvenile mandibular chronic
       osteomyelitis: a distinct clinical entity. Int. J Oral Maxillofac Surg 2003;32:459-468
   4. Arpornmaeklong, P., Shand, J.M., Heggie, A.A., Stability of combined Le Fort I maxillary
       advancement and mandibular reduction. Aust Ortho J 2003;19:57-66.

Department of Plastic & Maxillofacial Surgery – Annual Report 2003/04                           15

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