Springer Science and Business Media LLC

Patient-specific implants (PSI) for cranioplasty are expensive, and cost remains the limiting factor in low- to middle-income countries. The authors describe a novel, reproducible and cost-effective method of designing prefabricated titanium PSI cranioplasty. Ten patients from June 2018 to December 2020 were included in this retrospective study. A three-dimensional stereolithography model was made on a custom-built 3D printer with variable layer heights to produce efficient and accurate details. A certain amount of defect in the temporal region was left uncovered to avoid complications related to temporalis muscle dissection. The stereolithography model with a cranial defect was reconstructed with modelling wax. The wax model was scanned with a blue light visible scanner. The digital data was transferred to the milling machine (Jayon Surgical®, Kerala, India), where a 1-mm-thick sheet of titanium was milled according to the specifications. RFCC scoring system was used for assessing cosmetic outcome. The mean duration of the surgery was 56.50 min, SD = 14.916 min (range 45–75 min). In 9/10 patients, the RFCC score was 4 points. No other complications were found at a minimum follow-up of 18 months in all patients. The cost per patient was approximately 30,000 INR or 400 US dollars. The average time required for us to get the PSI ready for surgery was about 15 days. The authors demonstrate a novel, cost-effective and reproducible method of PSI using titanium for cranioplasty.

Malignant tumours in the parotid gland can originate either from the gland itself or as a result of metastatic spread of other tumours, such as cutaneous squamous cell carcinomas (CSCC) of the head and neck area. The aim of this study was to analyse and compare the clinical behaviour of primary as well as CSCC metastatic parotid cancers with special emphasis on therapy and oncologic outcome. Clinical and histopathological data of 342 patients with parotid gland malignomas surgically treated in a tertiary referral centre between 1987 and 2015 were retrospectively assessed. Oncologic outcomes of all cases with CSCC metastasis of the parotid gland (n = 49) were compared to those of primary parotid gland carcinomas (n = 293). Mean age at diagnosis was 72.3 years for CSCC patients versus 56.8 years in patients with primary parotid carcinoma. A total of 83.7% of CSCC patients were male, compared to 48.8% in the group of primary carcinomas. Forty-five out of 49 CSCC patients underwent total parotidectomy and neck dissection (91.8%). A total of 93.9% out of all CSCC patients received adjuvant radiotherapy. Five-year overall survival (OS) was 32.6% in CSCC patients versus 77.2% in primary parotid carcinoma patients. As compared to primary parotid cancers, we could show that patients suffering from CSCC metastases to the parotid gland presented with significantly higher age and worse survival.

Healthcare information is becoming more readily available and searched for online, particularly on websites such as YouTube™. The accuracy and content of these websites is often questionable. We aimed to evaluate the quality of information available on surgical extraction of wisdom teeth on YouTube™. We searched for the terms ‘wisdom teeth’, ‘third molar’, and ‘wisdom tooth extraction’ on YouTube™. The first 3 pages of results for each search term were assessed for inclusion and were independently rated by two assessors. Three separate scales to rate the quality of online information were used—DICSERN (range 0–5), HONcode (range 0–8) and the Global Quality Scale (GQS)(range 1-5). Cohen’s kappa test was used to assess inter-rater reliability. The searches returned 179 videos, but 114 were excluded (37 duplicates, 3 unrelated, 57 non-surgical, 13 <10k views, 4 non-English). Of the 65 videos included, the average length was 6 minutes and 34 seconds, and the average percentage positivity was 89%. The mean DISCERN score was 1.47 (SD 1.13), and the mean score for GQS was 2.15 (SD 0.6). No video met all HONcode criteria with the mean score being 2.96 (SD 0.9). There was good inter-rater reliability for the DISCERN score (kappa= 0.744) and HONcode score (kappa =0.866) but less reliability for GQS (kappa = 0.204). The standard of information on YouTube™ on surgical extraction of wisdom teeth varies, but is of poor quality overall. Patients should be advised to be cautious of such sources for information on this topic.

This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics. In a randomized, controlled, single-blinded procedure, 87 men and women aged 18–44 years were divided into two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery. Time from the end of operation until first rescue pill (400 mg Ibuprofen tablet) differed significantly between the M + S group (193 min) and the C group (110 min) (p = 0.001) as well as the M + T group (157 min) and the C group (p = 0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1 mg/kg tramadol under midazolam sedation. The lack of significant difference between the study and placebo groups indicates that tramadol at 1 mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies.