Caroline Mills

Cosmetic facial surgery: are online resources reliable and do patients understand them?

Our aim was to assess the quality and readability of online resources regarding common cosmetic maxillofacial procedures. We searched Google for rhytidectomy, rhinoplasty, orthognathic surgery, genioplasty, malar implants, blepharoplasty, otoplasty, and related terms. In each case we assessed the top 50 results for quality and readability. Quality was measured using the DISCERN questionnaire, benchmark criteria published by the Journal of the American Medical Association (JAMA), and accreditation by the HONcode (Health On the Net code). The Flesch-Kincaid reading grade, Flesch reading ease score, Gunnings fog index, and the Coleman-Liau index, were used to measure readability. A total of 350 sites were assessed and 200 were included in the study. The mean (SD) JAMA and DISCERN scores for all included websites indicated poor quality (0.49/4 (1.07) and 32.77/80 (10.57), respectively). Only eight sites (4%) were certified by the HONcode. There was a significant association between low DISCERN scores and Google Ads (p=0.009) and between low DISCERN scores and the websites of private clinicians or hospitals (p<0.001). The mean (SD) Flesch reading ease score and Gunnings fog score both indicated poor readability that required a moderately high level of literacy (50.59 (11.82) and 13.83 (2.76), respectively). The Flesch-Kincaid and Coleman-Liau scores indicated similar results. Adherence to the JAMA benchmark, certification by the HONcode, and relevant selection on Google Ads would improve quality. The avoidance of medical jargon and use of shorter sentences would improve readability and provide patients with comprehensible explanations that would allow them to have realistic expectations and take responsibility for their own health.

Costochondral grafting for paediatric temporomandibular joint reconstruction: 10-year outcomes in 55 cases

Costochondral grafting (CCG) can be used for the reconstruction of ankylotic, hypoplastic, and resected temporomandibular joint (TMJ) defects. CCGs have previously been considered the gold standard in children due to their growth potential and autogenous origin, but the disadvantages are unpredictable growth and joint ankylosis. This was a retrospective study of all children who received CCGs for TMJ reconstruction from 1985 to 2004, to allow a 10-year follow-up. Fifty-five patients were included in this study, with 74 grafts being placed; their mean age was 7.9±4.2years. Infection-related ankylosis (18.2%) and craniofacial microsomia (16.4%) were the most common diagnoses. Overall, 58.2% of patients suffered one or more complications over the follow-up period, with ankylosis (32.7%) and overgrowth (16.4%) being most common. There was a significant correlation between those with infection-related ankylosis and subsequent complications (χ2=8.8, df=1, P<0.005), while ankylotic patients in general exhibited greater overall complication rates (χ2=9.0, df=1, P<0.005). Patients with congenital TMJ defects were more likely to be complication-free than those with acquired defects (χ2=4.0, df=1, P<0.05). Caution is advised when placing CCGs in paediatric patients with ankylosed TMJs, especially those with infection-related ankylosis.

Head injury and the internet: are resources reliable and readable?

The Internet is the leading source of pubic health care information and patients who suffer a head injury (HI) are likely to access these resources at some point during their care. ‘Google’ (www.google.com) is the UK’s most popular search engine by far with an 83.5% market share (www.statista.com), however, health information is widely unregulated and may be biased, inaccurate or incomprehensible due to poor health literacy (and thus poorly understood). Health-related seals of approval (HRSA), such as HONcode accreditation (www.hon.ch/HONcode), try to ensure that resources adhere to certain standards but currently this is not common practice. The aim of this study was to provide an insight into the quality and readability of HI resources currently available on the Internet.

Electronic Follow-Up of Developing World Cleft Patients: A Digital Dream?

OBJECTIVEnTo identify potential access to telemedicine follow-up of children with clefts operated on a humanitarian mission.nnnMETHODSnA cross-sectional study of parents of children presenting to a humanitarian cleft lip and palate mission in a Provincial Hospital in the Philippines. A purpose designed questionnaire was used to assess access to electronic and digital resources that could be used to aid follow-up. Forty-five (Nu2009=u200945) parents of children having primary cleft lip and or palate surgery participated. There were no interventions. Access to the Internet was through Parent Perceived Affordability of Internet Access and Parent Owned Devices.nnnRESULTSnThirty-one (Nu2009=u200931) respondents were female. There was 93% mobile phone ownership. The mean distance traveled to the clinic was 187u2009km. Majority (56%) were fluent in English. Thirty-one percent accessed the Internet daily. Sixteen percent reported use of e-mail. Fifty-one percent accessed the Internet on a mobile device, and short message service use was the most affordable means of communication.nnnCONCLUSIONSnDue to perceived unaffordability and low levels of access to devices with cameras and the Internet, as well as issues with privacy, we cannot recommend relying on electronic follow-up of patients in the developing world.

Mandibular osteomyelitis after group A streptococcal septicaemia in a child.

Mandibular osteomyelitis in children is rare, and usually dontogenic in origin.1 We have read of only two other children with septicaemiaelated mandibular osteomyelitis, in both of whom it was n acute presentation in a newborn baby and was related to ethicillin-resistant Staphylococcus aureus.2,3 We describe n unusual case secondary to life-threatening septicaemia, ith a successful outcome after operation. A two-year-old boy was referred by his dentist to a speialist children’s oral and maxillofacial unit, because of an symptomatic “firm white plaque” in the lower right quadant. He had non-tender, exposed bone (8 × 12 mm) around he apex of his right mandibular canine with diffuse mucosal rythema. His teeth had no caries, but teeth B, C, and D had rade II-III mobility. His medical history showed that three months earlier he ad developed group A streptococcal septicaemia secondary o varicella zoster. This rapidly deteriorated into sepsisssociated, disseminated intravascular coagulopathy, and led o multiple organ failure. He had had a cardiac arrest on ransfer to a children’s intensive care unit, and had had a hromboembolism that affected the first and second toes on is left foot. Shortly after admission, a purpuric swelling of his chin nd neck was noted on the right. Ultrasound examination howed extensive oedema but no necrosis or collection. This esolved completely after eight weeks of combined antimirobial treatment given intravenously (antimicrobial drugs: ntravenous ceftriaxone, clindamycin, vancomycin, gentamcin and fluconazole, and oral amoxicillin). Before this illness is medical and social history had been unremarkable. This secondary presentation was indicative of chronic steomyelitis, with the characteristic features of exposed one and sequestration.4 Initial management was conservaive, with regular review and antibiotics given orally, because e had no symptoms and we wanted to prevent damage to his