Craniofacial Disorders and Cranio Maxillofacial Trauma

Details

Title

Craniofacial Disorders and Cranio Maxillofacial Trauma

Type

Stage Two

Module code

HPE409

Requirement

Compulsory

Module objective

This module builds on Stage 1 Orofacial Disorders, Elective and Trauma by adding complexity and a higher  level of understanding. By the end of this module the Clinical Scientist in Reconstructive Science will be able to analyse, synthesise, evaluate and apply knowledge of appropriate craniofacial surgery and reconstructive principles, medical device utilisation and manufacture relevant to clinical practice in a healthcare setting. This will include interpretation of multimodal radiological investigations, analogue patient models and 3D photographic and surface scanning techniques, and the application of the different data sets to select the specific anatomical reference required. They will be able to manipulate this data to provide concise simulated surgical plans for the multidisciplinary craniofacial team. They will design innovative devices for surgical planning and peri-operative surgical guidance in the clinical and operating theatre settings to improve treatment outcomes.

They should consistently demonstrate the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist, bringing the highest levels of knowledge and skill at times of basic human need when care and compassion are what matters most. The Consultant Clinical Scientist in Reconstructive Science will be expected to be able to contribute to national guidelines on the treatment of patients with craniofacial disorders and cranio maxillofacial trauma.

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 planning the treatment of congenital or traumatically acquired craniofacial anomalies in relation to craniofacial disorders and cranio maxillofacial trauma, including the:

• anatomy of the orofacial skeleton, nasal bones, jaws, orbit and contents;
• anatomy of in terms of reconstruction donor sites;
• pathological disruption of the anatomy caused by craniofacial anomalies and pan-facial trauma.

Craniofacial Disorders

• embryology of the pharyngeal arch development and syndromes arising from developmental pathology, e.g. cleft lip malformations;
• common craniofacial disorders, including Crouzon syndrome, Treacher Collins syndrome (TCS) and hemifacial microsomia (HFM);
• classification of these anomalies, e.g. OMENS classification of HFM;
• principles of advanced orthognathic surgical techniques, including multipart segmental and distraction osteogenesis (bone transport);
• surgical approaches to the craniofacial skeleton in the context that they will influence the surgical planning process;
• pre-operative facial analysis identifying the best resources available, e.g. camera systems, CT, CBCT and software analysis in surgical planning;
• post-operative facial analysis to analyse staged multiple surgical procedures, audit planning and surgical outcomes, identifying the best resources available;
• complexity associated with the treatment of children; parental guilt and additional support and training need to mange this

Cranio Maxillofacial Trauma

• aetiology of complex facial trauma and its treatment pathway;
• classification and identification of complex facial trauma for planning;
• interpretation of analogue dental casts and radiological investigations to inform the surgical plan;
• gathering clinical and patient information, making indicative plans and establishing timelines and care involved in treatment;
• process of undertaking and overseeing laboratory made device manufacture, materials selection, quality assurance and application;
• medical device regulations and their implementation;
• control of cross-contamination, including implementation;
• pre-operative application of 3D planning software and rapid prototyping;
• use of dental materials, equipment and techniques to manufacture routine and complex surgical devices.

Neurosurgery

Surgical techniques, rationale, postoperative appearance, function and reconstruction in respect of Reconstructive Science following:

• decompressive craniectomy for traumatic brain injury, stroke, oedema and/or refractory intracranial hypertension;
• craniotomy following excision of tumours originating from or invading the skull vault;
• implant materials selection and manufacturing techniques;
• legal and regulatory factors for deep buried implants, e.g. NICE guidelines;
• design and manufacture principles.

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 relevant to the planning of cases for  craniofacial surgery, neurosurgery, and trauma of the head and neck, including:

Trauma

• delivery of, analogue and digital plans for discussion with the MDT;
• utilise 3D models for the planned reduction osteotomies and trauma plate fabrication prior to theatre in complex pan-facial injuries;
• design and manufacture custom-made implants for complex reconstruction, e.g. custom orbital floor implants;
• assessment and analogue models and digital data for the manufacture of devices in complex cases involving mixed dentition where the occlusion is not easily determined.

Craniofacial

• delivery of analogue and digital plans for discussion with the MDT;
• undertake distraction osteogenesis plans to facilitate improved transport vectors and devise custom medical devices, e.g. to reduce occlusal interference;
• design and manufacture custom-made implants for complex reconstruction;
• manufacture and oversight of associated medical devices for craniofacial deformity management involving craniofacial osteotomies, e.g. cranioplasty fabrication;
• supervise and quality assure the manufacture of implantable medical devices for craniofacial reconstruction;
• adapting commercially available products to provide a custom solution to the patient, e.g. adapting off-the-shelf trauma plates or distracters;
• design and manufacture custom-printed surgical guide splints, e.g. 3D printed orthognathic wafers.

In relation to the case complexity described the Clinical Scientist in HSST will:

• interpret and evaluate digital data from CT, CBCT and be able to identify anatomical landmarks and isolate them for 3D build (grey scale Hounsfield Units);
• recognise where information may be required and request it appropriately;
• use skills of analysis and diagnostic synthesis, judgement and surgical planning pertaining to the conditions described in this module;
• evaluate and audit long-term outcomes to improve patient care and share best practice.

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  craniofacial  disorders  and  cranio  maxillofacial  trauma.  They will communicate effectively with patients, carers and the MDT. They will:

• in conjunction with the MDT analyse the patient in the trauma clinic to establish the technical options available to optimise the reconstruction, e.g. in those cases where the occlusion is not easily determined;
• in conjunction with the MDT analyse the patient in the craniofacial clinic to establish the technical options available to optimise the surgery, e.g. advise on application of surgical cutting guides;
• communicate effectively and skilfully with patients, carers and the MST;
• recognise the clinical characteristics of craniofacial syndromes and the impact of the altered anatomy for patients;
• recognise skeletal and dental relationships, utilising multi-model sources such as cephalometric analysis;
• provide oral and written advice to the wider team, e.g. central sterilisation units, and to the patient to manage any custom medical devices postoperatively.