Module information
Module details
- Title
- Prosthetic Reconstruction, Rehabilitation & Surgical Planning
- Type
- Specialist
- Module code
- S-R-S2
- Credits
- 30
- Phase
- 3
- Requirement
- Compulsory
Aim of this module
This module aims to consolidate learning, focusing on direct patient care, supervised clinical treatment and independent working. Trainees are expected to manage their time, practicing in a more time sensitive environment. This module will aim to develop communication skills and the ability to work as a member of the multidisciplinary team, contributing to more complex cases in trauma, oncology and craniofacial reconstruction and rehabilitation.
Work-based content
Training activities
| # | Learning outcome | Training activity | Type | Action |
|---|---|---|---|---|
| # 1 | Learning outcome 1, 2, 3, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Plan, design and manufacture custom occlusal fixation devices as part of the management of a complex middle third trauma case and evaluate against treatment goals |
Type DTA | Action View |
| # 2 | Learning outcome 1, 2, 3, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Undertake pre-surgical planning on a 3D printed model for a simple orbital floor repair. Plan design and manufacture a custom implant using either stock plate adaption or a custom design and evaluate against treatment goals |
Type DTA | Action View |
| # 3 | Learning outcome 1, 2, 3, 5, 6, 7, 8, 9, 10, 12 |
Training activities
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 DTA | Action View |
| # 4 | Learning outcome 1, 2, 3, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Plan, design and manufacture custom mandibular advancement devices for the treatment of sleep apnea. Assess the device in the outpatient clinic and adjust with the patient and evaluate against treatment goals |
Type DTA | Action View |
| # 5 | Learning outcome 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Plan design and manufacture a custom made deep buried implant for a body contour defect (bone or soft tissue) or a custom implant to support facial palsy/weakness/paralysis |
Type DTA | Action View |
| # 6 | Learning outcome 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Plan, design and manufacture a custom medical device for a patient requiring maxillary obturation using osseointegrated implants Discuss the long-term treatment options for the case with a Consultant in restorative dentistry |
Type DTA | Action View |
| # 7 | Learning outcome 1, 2, 3, 4, 5, 6, 8, 9, 10, 12 |
Training activities
Perform a systematic examination of a patient with a combined oral and extra oral deformity. Design and manufacture the prostheses |
Type DTA | Action View |
| # 8 | Learning outcome 1, 2, 3, 4, 5, 6, 8, 9, 10, 12 |
Training activities
Lead an assessment for a patient referred for a custom ocular prosthesis. Discuss individual patient requirements and prosthetic rehabilitation Plan, design and manufacture the final prosthesis and provide aftercare support |
Type DTA | Action View |
| # 9 | Learning outcome 1, 2, 3, 4, 5, 6, 8, 9, 10, 12 |
Training activities
Lead an assessment for a patient newly referred for a custom nipple areola complex. Discuss individual patient requirements and prosthetic rehabilitation Plan, design and manufacture the final prosthesis and provide aftercare support |
Type DTA | Action View |
| # 10 | Learning outcome 1, 2, 3, 4, 5, 6, 8, 9, 10, 12 |
Training activities
Lead a new patient assessment for a digit prosthesis. Discuss individual patient requirements and prosthetic rehabilitation Plan design and manufacture the final prosthesis and provide aftercare support |
Type DTA | Action View |
| # 11 | Learning outcome 1, 2, 3, 4, 5, 6, 8, 9, 10, 12 |
Training activities
Lead an assessment for a newly referred paediatric patient requiring an auricular prosthesis who has a congenital deformity. Discuss individual patient requirements and prosthetic rehabilitation Plan, design, manufacture and fit the final prosthesis. Provide aftercare support |
Type DTA | Action View |
| # 12 | Learning outcome 1, 2, 3, 4, 5, 6, 8, 9, 10, 12 |
Training activities
Lead an assessment and discuss with a patient their requirements and expectations for a remake of a nasal prosthesis Plan, design, manufacture and fit a nasal prosthesis based on their individual concerns, prognosis and their individual requirements |
Type ETA | Action View |
| # 13 | Learning outcome 1, 2, 3, 4, 5, 6, 8, 9, 10, 12 |
Training activities
Lead an assessment and discuss with the individual patient their requirements and expectation for a remake of an orbital prosthesis Plan, design and manufacture the final prosthesis including the ocular component and provide aftercare support based on their individual concerns, prognosis and their individual requirements |
Type ETA | Action View |
| # 14 | Learning outcome 1, 2, 3, 4, 9, 12 |
Training activities
Identify a case where there is a need for further patient support. This may include psychological, emotional and financial difficulties Discuss the patient support requirements with the Specialist Nurse responsible for their care |
Type DTA | Action View |
| # 15 | Learning outcome 1, 2, 10, 11 |
Training activities
Complete a clinical audit to specifically determine patient satisfaction within an area of prosthetic service |
Type DTA | Action View |
| # 16 | Learning outcome 1, 2, 3, 4, 6, 8, 9, 10, 12 |
Training activities
Lead a patient assessment for dynamic splint therapy following facial burns. Discuss individual patient requirements and prosthetic rehabilitation Plan, design, manufacture and fit the final therapeutic splint and provide aftercare support |
Type DTA | Action View |
| # 17 | Learning outcome 1, 2, 3, 4, 6, 7, 8, 9, 10, 12 |
Training activities
Plan design and manufacture a nasal septal obturator to occlude a septal defect |
Type DTA | Action View |
| # 18 | Learning outcome 1, 2, 3, 4, 6, 8, 9, 10, 12 |
Training activities
Plan, design and manufacture a custom-made device to support a patient post laryngectomy to improve speech and communication and evaluate against treatment goals |
Type DTA | Action View |
| # 19 | Learning outcome 1, 2, 3, 4, 6, 8, 9, 10, 12 |
Training activities
Plan, design and manufacture devices to support therapeutic radiotherapy considering the safety and comfort of patients |
Type DTA | Action View |
| # 20 | Learning outcome 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Undertake cephalometric analysis of a specific orthognathic patient with the Consultant Orthodontist Review the information to define the provisional surgical plan |
Type DTA | Action View |
| # 21 | Learning outcome 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Lead the planning of a complex segmental (analogue) orthognathic bimaxillary surgical case Provide the multidisciplinary team with a comprehensive plan, design and manufacture the surgical occlusal splints |
Type DTA | Action View |
| # 22 | Learning outcome 1, 2, 3, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Provide pre-operative orthognathic planning for a bi-maxillary procedure with computer aided design (CAD) planning, design and print surgical occlusal splints using computer aided manufacture (CAM) |
Type ETA | Action View |
| # 23 | Learning outcome 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Investigate complex craniofacial deformity treatment using simple single vector distraction Exploring the device options and present the definitive treatment plan to the multidisciplinary team |
Type DTA | Action View |
| # 24 | Learning outcome 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Provide pre-operative CAD planning, and CAM 3D models for the management of head and neck oncology and present the model in a clinic for discussion and planning with the surgeon |
Type ETA | Action View |
| # 25 | Learning outcome 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 |
Training activities
Plan and design a cranioplasty implant using advanced CAD planning, and CAM 3D models Design the custom device ‘in -house’ and research an external manufacturer for the production/manufacture |
Type DTA | Action View |
| # 26 | Learning outcome 1, 2, 3, 9, 10, 12 |
Training activities
Complete patient records for each stage of treatment when providing a patient with a facial prosthesis Identify the relevance and implications for continuity in patient care, as a professional and your Trust |
Type ETA | Action View |
| # 27 | Learning outcome 2, 3, 10, 11 |
Training activities
Retrieve retrospective data from the MDR system to perform a medical device audit and evaluate a specific group of custom medical devices. Present findings at a local meeting |
Type ETA | Action View |
| # 28 | Learning outcome 1, 2, 3, 8, 10, 11 |
Training activities
Evaluate the adaption of a stock medical device to meet the needs of a patient and present the impact on the patient outcomes |
Type DTA | Action View |
| # 29 | Learning outcome 1, 2, 8, 10, 11 |
Training activities
Perform an assessment of a new material being used in the production of a custom-made medical devices in the laboratory |
Type DTA | Action View |
| # 30 | Learning outcome 1, 2, 3, 9, 10, 11, 12 |
Training activities
Attend a morbidity and mortality (M&M) clinical governance meeting Bring lessons back into the laboratory regarding a specific case. Make recommendations about practice within the department |
Type DTA | Action View |
Assessments
Complete 6 Case-Based Discussion
Complete 6 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Take a facial impression for an implant retained prosthesis.
- Direct colour match a patient skin shade and colour match swatches (details) using traditional analogue processes (non-digital).
- Complete extrinsic pigmentation for a prosthesis and provide final patient handover instruction.
- Manufacture a custom implant retention bar for an auricular prosthesis.
- Create a STL file from DICOM data and print a 3D model.
Observed Communication Event Titles
- Undertake a new patient assessment including social/medical history and consent.
- Discuss the design for an oral obturator device with a Consultant in Restorative Dentistry.
- Present a facial prosthetic patient history and your treatment plan.
- Discuss a definitive auricular prothesis with a patient, with reference to their expectations and thoughts on the device.
- Discuss your design of intra oral fixation for a current trauma case with the Surgeon.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Deliver quality patient centred care with the best interests of patients in all elements of practice. |
| 2 | Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance. |
| 3 | Communicate effectively with patients, relatives, healthcare professionals and other stakeholders. |
| 4 | Identify patients who need further specialist support and refer to the appropriate healthcare specialist. |
| 5 | Analyse and interpret patient investigations, multimodal imaging and information. |
| 6 | Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard. |
| 7 | Prepare surgical treatment plans for complex head and neck surgery. |
| 8 | Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices. |
| 9 | 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 | Apply the principals of a quality management system to their professional practice. |
| 11 | Support innovation and development and participate in research, audits and service evaluations. |
| 12 | Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements. |
Clinical experiences
Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.
Activities
- Attend theatre for a complex middle third facial trauma to appreciate how devices are applied in surgery and the relevance to the patient outcome.
- Attend theatre for a hemi maxillectomy or maxillectomy to appreciate how devices are applied in surgery and the relevance to the patient outcome.
- Follow a patient through a complete specialist maxillofacial/restorative dentistry treatment to appreciate the patient treatment pathway and patient experience.
- Attend a theatre for a cranioplasty surgery to appreciate how devices are applied in surgery and the relevance to the patient outcome.
- Attend a follow up clinic with the maxillofacial oncology team to appreciate the process of short- and long-term review.
- Visit a commercial additive manufacture centre.
- Attend the orthognathic multidisciplinary team and follow a patient through treatment.
- Attend a clinic appointment where a 3D model is used to explain treatment to a patient.
- Visit the PALS service to appreciate their role in patient support.
- Follow patient journey for a complex surgical resection from diagnosis, to the multidisciplinary team, planning, surgery and post-operative follow up.
- Attend a patient support group to appreciate the support available to patients undergoing treatment and rehabilitation.
- Attend the multidisciplinary team outpatient appointments and surgery for a simple mandible or maxillary distraction case.
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
On successful completion of this module the trainee will be able to:
- Demonstrate extended understanding of legal, ethical and quality management system requirements in the manufacture of medical devices.
- Critically analyse the physical and psychological responses to illness/injury and the use of quality of life measures/outcomes in the treatment and rehabilitation of reconstructive science patients.
- Apply theoretical principals of material properties and performance in the design and justify treatment plans for the provision of complex facial/body prostheses for reconstructive science patients.
- Critical analyse new developments and scientific advances in biomedical materials, manufacturing techniques and clinical performance and discuss their application for new and innovative treatments.
- Discuss the treatment options and plans for patients undergoing complex craniofacial surgery for a complex cranioplasty and analyse pre-surgical plans with analogue and digitally techniques.
- Discuss the epidemiology, causes, incidence, classification, treatment and preventative strategies with respect to complex fractures of the middle third of the facial skeleton.
- Evaluate, design and treatment constructional techniques of complex obturators and appliances used in peri-operative in intermediate and definitive stages of treatment.
- Discuss the process of scar formation its incidence and aetiology, appearance, classification of chemical and thermal injuries of the skin, the treatment of hypertrophic, dynamic splinting and the manufacture of radiation applicators and shields and other devices used in radiotherapy treatment.
- Critically explain the epidemiology, pathogenesis, behaviour, diagnostic investigations and management of swellings of the head and neck and the surgical procedures relevant to the excision of neoplasms and the provision of prostheses.
Indicative content
Risk management and governance:
- National and international standards and guidance
- Compliance with the requirements of Medical Devices Directive (MDD)
- Device classification
- Clinical governance framework
- Current standards and compliance in the healthcare environment, including standards for better Health, NHS Litigation Authority (medico legal aspects)
- Management of innovation and prototypes
- Medico legal aspects
Surgical procedures and devices:
- Information required for different surgical procedures (CT scans, 3D models etc,)
- Different surgical procedures relevant to the provision of prostheses (i.e. skin grafts, bone grafts, tissue expansion, flaps and resection)
- Diagnostic investigations of swellings of the head and neck
- Principles of soft tissue surgery and plastic surgery
- Principles of tissue transfer and graft support appliance design
- Comparative treatments and evaluation of splint appliances
Complex fracture cases:
- Treatment of complex fracture cases of the middle third of the face
- X-ray appearance dental mandibular fractures e.g. orthopantomograms. (OPG), posteroanterior (PA)
- Clinical assessment of patients
- Common sites and displacement of facial fractures
Patient management and psychology:
- Care pathways and referral for social and psychological support
- Patient and carer education
- Management of patients fears/anxiety and ability to empathise with patients in stressful situations, and the manifestations of anxiety and pain including the range of techniques available in their management and control
- Personal and professional interaction with terminally ill patients, including knowledge of counselling skills
- Recognition and appropriate care of patients with tissue conditions (psoriasis, eczema, contact dermatitis, dry mouth, burning mouth syndrome and underlying health issues
- Theories and evidence base underpinning health related behaviour, common psychosocial disorders (abnormal psychology, anxiety, depression psychoses, eating disorders, alcoholism and drug addiction)
- Process of grief and loss
- Role of support groups
- Quality of life outcome measurement and analysis
Digital technology:
- Principles of image guided surgery and digital planning and its implications in maxillofacial and craniofacial surgery
- New developments in digital analysis
- Assessment in pre/post-operative outcomes
- Anatomical models from 3D data (i.e. CNC milling, rapid prototyping)
- Manufacture and accuracy of 3D models used to create facial prostheses and templates
Dynamic splint therapies:
- Anatomy and pathology in relation to skin and thermal injury
- Patient protocols, management of the burns patient, scar review and scar indexing
- Post burn trauma therapy, aetiology and assessment of condition
- Radiation applicators and shields
Complex skull cranioplasties:
- Types of cranioplasties
- 3D technologies and software
- Analogue and digital techniques
- Materials used
- Infection control
Dentures and complex obturation:
- Legal, ethical, professional and technical issues associated with the provision of dentures and obturators
- Surgical splint design principles
- Classification of post-surgical defects and effect of defect on prosthodontic design
- Trismus
- Materials and techniques used in obturator construction
- Design features of obturator prostheses (i.e. Open box, glove obturators, obturator retention, and soft palate obturation)
- Intermediate/definitive obturator prostheses for partially dentate patients
- Surface finish of prostheses and microbial colonisation and degradation of silicone elastomers
- Two-part dentures and design criteria
Ocular Prosthetics:
- Anatomy, aetiology and assessment of condition
- Intra orbital implant consideration
- Ocular socket microbiology and reaction to materials
- Recognition and pathology of diseases of the ocular socket and globe
- Surgical techniques associated with indwelling ocular prostheses
- Impression material selection and techniques
- Ocular manufacture
- Recognition of condition and diseases associated with indwelling ocular prostheses
- Cleaning and surface analysis of prostheses
Facial/Body Prosthetics:
- Principles of management of facial prostheses, pre-treatment assessment, treatment planning and design, and pre-prosthetic surgery
- Novel developments in facial and body prosthetics
- Direct and indirect impression techniques and materials
- Facial prosthetic materials, properties, biocompatibility and colouration
- Retention and methods of support of facial prostheses
- Digit and nipple protheses