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Two cases of formalin toxicity developed within 5 to 10 minutes of the placement of packs soaked in formalin within hepatic hydatid cysts. Hypotension, severe tachycardia, postoperative anuria, tachypnoea, restlessness, unconsciousness and coma developed. There was no response to the treatment given. Treatment was continued for about 12 hours. The problems associated with the use of formalin are discussed.

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Introduction: Use of patient specific Polymethyl methacrylate (PMMA) implants for the reconstruction of cranial defects has become a standard practice with excellent long-term results. However, for the reconstruction of midface and mandibular osseous defects other alloplastic materials are preferred but their use is limited due to high cost. This is a report of our experience with the use of low-cost patient specific PMMA implants fabricated using 3D printed moulds in the reconstruction of osseous defects involving different areas of the facial skeleton not limited to cranium. Methods: The 25 consecutive patients with craniofacial osseous defects who underwent reconstruction using customized PMMA implants were analyzed. All PMMA implants were fabricated intraoperatively with the use of 3D printed flexible moulds or templates.Results: A total of 34 implants were used in 25 consecutive patients. Out of 34 implants 25 were used for midface and mandibular osseous defects. Most common etiology was posttraumatic deformity (n ¼ 19) followed by tumor (n ¼ 3), craniofacial anomalies (n ¼ 2) and post-craniotomy (n ¼ 1). One patient out of 25 (n ¼ 1) had postoperative implant exposure. The follow-up was ranged from 3 to 19 months with an average of 12 months. The aesthetic outcome was found to be good to excellent with mean visual analogue score of 4.08. Conclusions: Polymethyl methacrylate implants fabricated intraoperatively using 3D printed moulds provide accurate and precise reconstruction at an exceptionally low cost. PMMA has an excellent moulding property with low infection rates. As shown in our study its application may be easily extended to all areas of the craniofacial skeleton.