Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 3

Details

Plan design and manufacture custom fixation devices for the management of complex mandibular fractures in the elderly, minimally dentate/edentulous patients and evaluate against treatment goals

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Considerations

• Patient centred care and support Indications for treatment
• Pre surgical planning using imaging, analogue models and a 3D model
• The information required prior to manufacture
• Device design, material selection and manufacture custom medical devices, e.g. gunning splints and arch bars with acrylic saddles
• Manufacture protocols and device risk assessment
• Use of the devices in theatre for inter-maxillary fixation and reduction
• Design, production and use of surgical occlusal guides
• Surgical fixation options, e.g. wiring or plating
• Evaluation of planned patient outcome
• Impact of plan/design on patient quality of life
• Communication with the multidisciplinary team
• National guidance and external resources for complex fracture management

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What are the unique challenges presented by elderly, minimally dentate/edentulous patients?
• How will you evaluate the effectiveness of the fixation devices?
• What specific design and manufacturing adaptations might be necessary for these patient groups?
• How will you consider the biomechanics and stability of the fixation in the absence of or with limited dentition?
• What will you learn about the evaluation process for these complex cases?
• Have you researched the specific considerations for mandibular fracture management in elderly and edentulous patients?
• Have you discussed different fixation techniques and materials with experienced colleagues?
• How will you incorporate knowledge of their anatomy and bone quality into your plan?

In action

• As you plan, design, and manufacture the fixation devices, are you consciously considering the specific challenges posed by elderly and minimally dentate/edentulous patients? What real-time modifications are you making to your standard approaches based on these factors? Are certain aspects of the planning or manufacturing feeling more familiar, while others require more focused attention due to the complexity?
• Are your planning and design processes effectively addressing the complexities of the mandibular fracture and the patient’s dental status? Are you encountering any unexpected difficulties in manufacturing devices suitable for this specific patient group? What immediate insights are you gaining into the unique considerations for managing such cases? How does this activity build upon your understanding of mandibular fractures and fixation techniques?
• If your initial designs or manufacturing techniques are not proving suitable, what alternative approaches are you considering ?  Do you need to seek immediate input from senior colleagues regarding the optimal fixation strategy? Are you ensuring that your actions align with best practices for managing complex mandibular fractures in this patient demographic?

On action

• Describe the specific considerations and challenges for planning, designing, and manufacturing custom fixation devices for this patient group. What factors related to the elderly, minimally dentate/edentulous status influenced your design and manufacturing process? Describe the planning, design, and manufacturing process of the custom fixation devices. How did the manufactured devices compare to the treatment goals for these complex fractures?
• What specific skills or knowledge did you develop or improve in creating fixation devices for complex mandibular fractures in this specific patient group? What did you learn about the management of mandibular fractures in elderly and edentulous patients? Were there any unexpected challenges or successes? What did you learn from these? How effective was the evaluation of the devices against the treatment goals?
• What areas for continued development have you identified in mandibular fracture fixation for these complex cases? How can you apply the knowledge and skills gained to future cases involving similar challenges? What resources or support might you need to further develop in this area?

Beyond action

• Have you revisited experiences of planning and manufacturing fixation devices for challenging mandibular fracture cases? How has your understanding of the specific needs of these patient groups changed?
• How have these experiences impacted upon your current practice in managing mandibular fractures in diverse patient populations? Have you refined your design or manufacturing techniques?
• How might these experiences contribute towards your future practice in managing even more complex or unusual mandibular fracture presentations? What did you learn about biomechanics and fixation principles?

Relevant learning outcomes

#	Outcome
# 1	Outcome Deliver quality patient centred care with the best interests of patients in all elements of practice.
# 2	Outcome Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance.
# 3	Outcome Communicate effectively with patients, relatives, healthcare professionals and other stakeholders.
# 5	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 7	Outcome Prepare surgical treatment plans for complex head and neck surgery.
# 8	Outcome Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	Outcome Practice in partnership with other clinical specialisms as part of a multidisciplinary team and understand their roles and their impact on patient care and pathway.
# 10	Outcome Apply the principals of a quality management system to their professional practice.
# 12	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.