Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 7

Details

Perform a systematic examination of a patient with a combined oral and extra oral deformity. Design and manufacture the prostheses

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
• Imaging and patient history
• Consent
• Information requirements to complete the device
• Considerations for design and manufacture, including patient prognosis and past treatments
• Design requirements and options related to anatomical structures
• Device design, material selection and manufacture custom medical devices
• Manufacture protocols and device risk assessment
• Patient expectations and experience
• Clinical fitting procedure
• Care and use instructions
• Interaction between the oral and extra oral device
• Communication with the patient and family/carers
• Communication with the multidisciplinary team providing ongoing care
• Impact of plan/design on patient quality of life

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 key elements of a comprehensive oral and extra-oral examination?
• How will you integrate the findings into the prosthetic design?
• What will you learn about conducting a thorough examination for complex deformities?
• How will you prioritize the prosthetic needs based on the patient’s presentation?
• What design and manufacturing techniques are suitable for addressing both oral and extra-oral components?
• Have you reviewed protocols for patient examination in maxillofacial prosthetics?
• Have you studied examples of prostheses for combined deformities?
• Have you discussed the examination and planning process with your training officer and restorative consultant?
• What are the likely challenges you will face in the design and manufacture process of the prosthesis and what limitations might there be.

In action

• While conducting the systematic examination and subsequently designing and manufacturing the prostheses, are you consciously noting the various aspects of the patient’s deformity and their interrelation? What immediate decisions are you making regarding the scope and sequence of your examination and the key features of the prostheses? Are you applying established examination protocols and prosthetic design principles as you progress?
• Is your systematic examination providing a comprehensive understanding of the patient’s needs? Are you encountering any challenges in translating your findings into effective prosthetic designs and manufacturing processes? What immediate learning is occurring as you integrate information from the oral and extra-oral examination? How does this activity connect to your knowledge of different types of oral and facial deformities and their prosthetic management?
• If the patient’s deformity presents unexpected complexities during the examination or if your initial prosthetic designs encounter limitations, what alternative examination techniques or design approaches are you considering at the moment? Do you need to consult with colleagues or refer to relevant literature for guidance on managing this specific combination of deformities? Are you ensuring that your examination and prosthetic work remain within your area of competence?

On action

• Describe the systematic examination process you undertook. What were the key findings from the examination regarding the patient’s combined deformity? What design considerations were crucial for addressing both the oral and extra-oral aspects of the deformity? Describe the manufacturing process for the prostheses.
• What specific skills or knowledge did you develop or improve in performing systematic examinations and designing prostheses for combined deformities? What did you learn about the challenges and considerations for treating patients with both oral and extra-oral deformities? Were there any unexpected challenges or successes during the examination, design, or manufacturing stages? What did you learn from these? How did the examination findings directly influence your design and manufacturing choices?
• What areas for continued development have you identified in examining and creating prostheses for combined deformities? How can you apply the knowledge and skills gained to future cases with complex presentations? What resources or support might you need to further develop in this area?

Beyond action

• Have you revisited experiences of assessing patients with combined deformities and creating appropriate prostheses? How has your ability to integrate oral and extra-oral considerations improved?
• How have these experiences impacted upon your current practice in patient assessment and complex prosthetic planning? Are you more confident in managing multi-site defects?
• How might these experiences contribute towards your future practice in treating rare or complex craniofacial conditions? What did you learn about systematic examination and holistic treatment planning?

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.
# 4	Outcome Identify patients who need further specialist support and refer to the appropriate healthcare specialist.
# 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.
# 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.