Cancer of the Head and Neck

Details

Title

Cancer of the Head and Neck

Type

Stage Two

Module code

HPE408

Requirement

Compulsory

Module objective

By the end of this module, the Clinical Scientist in Reconstructive Science will be able to apply their acquired knowledge, skills and experience in the clinical setting to safely undertake a range of procedures in the treatment of patients with head and neck cancer as part of the MDT. The Clinical Scientist in HSST will most commonly work within a team that delivers these services to head and neck oncology patients. The balance between their clinical and technical role will relate to the presence of other clinicians within the MDT.

Working closely with the MDT that may include consultants in maxillofacial surgery, otorhinolaryngologists, oncologists, plastic surgeons and restorative dentists (following national guidelines: NICE), they will provide input and expert opinion on Reconstructive Science services for pre-treatment, peri-treatment and post-treatment (to include surgery). This will include conventional and digital planning methods and, where appropriate, the manufacture of custom-made devices. For the manufacture of intra-oral devices such as peri- and post-surgical obturators the Reconstructive Scientist will be working under the direction of a dentally qualified MDT member such as a maxillofacial surgeon and/or consultant in restorative dentistry. They will undertake limited clinical stages as defined by their competencies and scope of practice for dental technicians and Reconstructive Scientists/maxillofacial prosthetists.

The Clinical Scientist will place the patient and patient safety at the centre of all care provided during treatment and rehabilitation maintaining a safe, quality assured service. The Consultant Clinical Scientist in Reconstructive Science will be expected to critically evaluate their own response to both normal and complex situations using the professional attributes and insights required. They should be aware of the impact of head and neck cancer on the patient, carers and the immediate family, and the range of support services available.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to include the:

Clinical Sciences

• anatomy of the orofacial skeleton, nasal bones, jaws, orbit and contents as related to planning, impression taking and construction of intra-oral medical devices;
• pathological disruption of the anatomy caused by cancer;
• epidemiology, pathology and having knowledge of the modes of invasion/spread of common orofacial malignancies;
• TNM classification and tumour staging system (a classification system for malignant tumours);
• common surgical approaches and techniques employed to remove oral and facial cancers and subsequently reconstruct the defect site;
• the potential common complications and side effects of cancer treatment that may impact on the patient treatment plan, particularly radiotherapy;
• awareness and requirements for satisfactory aesthetic and functional reconstruction and rehabilitation;
• alternatives to surgical treatment;
• protocols and conduct when attending the operating theatre.

Pre-Surgical Planning

• requirements for routine and complex pre-surgical and peri-surgical devices;
• how a Clinical Scientist in HSST works within a MDT environment and within professional boundaries;
• evaluation and selection of materials, equipment and techniques to manufacture routine and complex surgical devices;
• work with the MDT to evaluate and analyse X-rays and CT scans for 3D modelling of the data to make pre- and post-surgical representations to the MDT;
• pre-planning surgical reconstruction flaps for full rehabilitation of the patient postop, e.g. shape/position of the bone flap for dental implants.

Reconstruction Planning

• anatomy of limbs, pelvis and skull in terms of reconstruction donor sites and bone healing;
• principles of flap surgery as related to Reconstructive Science rehabilitation;
• knowledge of the classification of flaps, e.g. local, free and composite;
• awareness of the advantages and disadvantages of various donor sites used for reconstruction of the head and neck and the implications on planning, such as volume and bone quality and pedicle length;
• use of surgical planning software in the planning phase to demonstrate outcomes to surgeons and the MDT.

Intra-Oral Rehabilitation

The Clinical Scientist in HSST will most commonly work within a team that delivers these services to head and neck oncology patients. The balance between their clinical and technical role will relate to the roles within the MDT. Rehabilitation in relation to intra-oral devices will need the relevant scope of practice modules/competencies undertaken and assessed. Knowledge will include:

• legal, regulatory, ethical and professional issues associated with the provision of intra-oral devices and clinical procedures;
• clinical input for the management of patients for the construction of intra-oral devices and obturators, to include impression techniques, trial assessment, fitting and review;
• the implications of post-surgical appearance and altered anatomy, classification of post surgical defects;
• the need for review, management and long-term maintenance
• technical and clinical requirements for the provision of immediate (peri-operative), intermediate and long-term intra-oral prostheses (including sectional and multipart obturators);
• interpretation of the post-surgical defect for design, planning and manufacture criteria for custom-made medical devices;
• dental materials, equipment and techniques to manufacture routine and complex removable devices;
• design criteria for fixed/implant retained devices;
• occlusal schemes and occlusion and how denture design can compromise function of compromised dental anatomy and lead to biomechanical damage to surrounding structures;
• current and seminal literature on indications and success/failure criteria and biomechanical implications of such restorations;
• adjunctive therapies, including speech and language, head and neck dieticians;
• role of ward-based nursing care and specialist support nursing such as Macmillan.

Extra-Oral Rehabilitation/Anaplastology

• application of anaplastology in relation to the head and neck patient (Anaplastology HPE407).

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will have a critical understanding of current evidence and its application to the performance and mastery of a range of technical skills and will:

• within the MDT environment analyse and evaluate multimodal data sources in respect of Reconstructive Science procedures;
• recognise when further information and expert opinion from other clinicians is required to optimise the clinical outcome and patient satisfaction;
• adapt data for 3D planning and prototyping in terms of reconstruction and rehabilitation;
• manufacture a broad range of surgical and post-surgical devices, including obturators, advising the MDT on patient-specific options;
• adapt broad knowledge and experience of device manufacture to produce innovative solutions for complex rehabilitation;
• manufacture medical devices used in oncology treatment requiring the highest level of technical expertise;
• be able to quality assure the design and manufacture of complex pre-operative and peri-operative devices that may include attachments to implants;
• use and develop skills of analysis, diagnostic synthesis and judgement pertaining to the conditions described in this module.

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills with respect to head and neck oncology. Clinical intra-oral work will be governed by professional boundaries, competencies and scope of practice and will always be undertaken with a dentally qualified member of the team. The Clinical Scientist in HSST will assist in the clinical management of surgical devices and obturators constructed to restore the defective tissues, including:

• undertaking limited clinical aspects of the construction of intra-oral devices and obturators, to include impression techniques, occlusal registration, face-bows and review in conjunction with specialist dental support, e.g. consultant in restorative dentistry. The treatment plan will be approved by the MDT team with clinical work overseen by appropriately trained clinicians;
• communicating effectively and skilfully in a variety of clinical situations where their expert opinion is required, e.g. in the operating theatre, in the MDT, or in the clinic;
• discussing complex treatment scenarios with patients, carers and the MDT, including discussion of all options, advantages and disadvantages, and taking informed consent where appropriate;
• coordinate Reconstructive Science services for theatre making sure all the relevant protocols are followed; this may involve education of theatre staff;
• the importance of working within a team for the best interests of the patient and a successful outcome.