Introduction to Reconstructive Science

Module details

Title

Introduction to Reconstructive Science

Type

Rotation

Module code

SPE400

Credits

10

Requirement

Compulsory

Aim of this module

This rotation will provide trainees with the knowledge and understanding of the range of services provided by Reconstructive Science, including the use of image data and reconstruction methods and their clinical application. Learning will be developed and applied in this module within the care pathway for the treatment of facial fractures, with other care pathways being considered at different stages of the STP. They will experience the range of services provided by reconstructive science in facial trauma, including the use of image data, reconstruction methods and their clinical application. They will perform some common techniques used for patient assessment as part of the treatment of maxillofacial trauma.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Identify the anatomical structures in the head and neck on an X-ray of a normal subject.	Action View
# 2	Learning outcome 1	Competency Identify the anatomical structures in the head and neck from a computed tomography (CT) scan of a normal subject.	Action View
# 3	Learning outcome 1	Competency Identify the anatomical structures in the head and neck from a magnetic resonance imaging (MRI) scan of a normal subject.	Action View
# 4	Learning outcome 1	Competency Identify the anatomical structures in the head and neck from X-rays and CT scans of patients with common oral and facial fractures.	Action View
# 5	Learning outcome 2	Competency Use image data and intra-oral casts of patients with oral fractures and apply anatomical knowledge to reconstruct oral and facial form.	Action View
# 6	Learning outcome 3	Competency Discuss patient treatment plans that require the manufacture of a device to support the treatment of dentoalveolar fractures with healthcare colleagues and the patient.	Action View
# 7	Learning outcome 3	Competency Discuss patient treatment plans that require the manufacture of a device to support the treatment of mandibular fractures with healthcare colleagues and the patient.	Action View
# 8	Learning outcome 4	Competency Apply relevant legal, professional and ethical requirements of manufacturing devices used for maxillofacial trauma.	Action View
# 9	Learning outcome 4,6	Competency Plan and manufacture devices for a patient with single and multiple dental alveolar injuries and temporomandibular joint (TMJ) relief.	Action View
# 10	Learning outcome 4	Competency Plan and manufacture arch bars for dentate patients with mandibular fractures.	Action View
# 11	Learning outcome 4	Competency Plan and manufacture devices for edentulous patients with mandibular fractures.	Action View
# 12	Learning outcome 5	Competency Assist colleagues performing routine maintenance on a range of equipment, including vacuum mixing machines and curing equipment.	Action View
# 13	Learning outcome 5	Competency Complete equipment maintenance records accurately.	Action View
# 14	Learning outcome 5	Competency Assist colleagues performing routine calibration and quality assurance on a range of equipment.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Prepare models for case with displaced unfavourable fracture	DOPS
Vacuum form a semi rigid thermoplastic splint to treat a dentoalveolar fracture	DOPS

Learning outcomes

1. Identify anatomical structures in the head and neck using digital imaging (CT, MRI, X-ray).
2. Use image data and intra-oral casts of patients with oral and facial fractures and apply anatomical knowledge to identify and reconstruct oral and facial form.
3. Discuss treatment plans for patients requiring devices to support the treatment of facial fractures with healthcare colleagues and the patient as part of the multidisciplinary team, considering the outcomes, safety, comfort and dignity of patients.
4. Plan and manufacture devices for a range of patients with facial fractures.
5. Assist in the routine maintenance, calibration and quality assurance procedures on the equipment used to plan and manufacture medical devices. 
6. Apply relevant legal, professional and ethical requirement guidelines of manufacturing devices used for maxillofacial trauma, e.g. the National Institute for Health and Clinical Excellence (NICE).

Learning outcomes

1. Identify the range of patients referred to a reconstructive science service and the care pathways to which the service contributes.
2. Describe and apply knowledge of the anatomy and physiology of the head and neck to the practice of Reconstructive Science.
3. Observe pro-dissection of the head and neck and relate to CT image data.
4. Discuss the role of medical artists, forensic reconstruction and the relationship of the associated science and technology with Reconstructive Science.
5. Describe the sites, incidence and aetiology of fracture and displacement  of facial fractures.
6. Describe the assessment, management and treatment of facial fractures.
7. Explain the potential routes of transmission of infectious agents in clinical practice, mechanisms for the prevention of infection, the scientific principles of decontamination and disinfection and their relevance to health and safety policies and the practice of Reconstructive Science.
8. Explain the selection, use and disinfection of impression materials used across Reconstructive Science and in particular in the treatment of facial fractures.
9. Explain the design, materials selection and use of custom-made splints for the treatment of maxillofacial trauma.
10. Critically evaluate the underlying risk, legal and ethical requirements in the manufacture of medical devices for maxillofacial trauma.

Indicative content

Introduction to Reconstructive Science

• Care pathways in Reconstructive Science
  • Patient demographics and requirements of a reconstructive science service, including:
  • road traffic accidents (pedestrians, cyclists, )
  • cancer
  • battlefield trauma
  • industrial injuries
  • sports injuries
  • physical violence
• Introduction to multidisciplinary care
• Evidence-based practice in Reconstructive Science
• Introduction to protection of children and vulnerable adults
• Social and demographic factors affecting incidence of oral and facial injuries
• Introduction to the management of reconstructive science services

Introduction to dental and periodontal injuries, and mandibular fractures

• Anatomy of the head and neck
• Incidence and aetiology of dental and periodontal injuries, and mandibular fractures
• X-ray appearance of normal tissue, and dental and mandibular fractures, e.g. orthopantomograms (OPG), posteroanterior (PA)
• Common sites of mandibular fractures fracture
• Displacement of mandibular fractures
• War and terrorism injuries

 Planning and preparing for treatment

• Indications and contraindications
• Adherence to health and safety of patient, public, staff and self
• Basic clinical assessment of patients
• Basic principles of infection control
• Knowledge of local and national guidelines specific to procedure
• Types of splint that may be prescribed and manufactured
• Factors affecting materials selection for splints and dental impressions
• Factors affecting properties of materials used for manufacturing splints during and after manufacture (corrosion, mechanical, allergy)

Techniques of facial reconstruction

• Reconstruction of facial form after mandibular fractures
• Direct and indirect surgical techniques for reduction and fixation of maxillofacial fractures
• Surgical techniques for facial reconstruction following trauma
• Post-surgical trauma care
• Factors affecting healing of facial fractures
• Soft tissue forensic reconstruction techniques
• Scope of practice of medical artists/photographers and use of 3D imaging

In this module trainees will develop detailed learning that underpins the routine practical techniques

• Manufacture of thermoformed dental splints
• Manufacture of thermoformed soft bite guards
• Manufacture of wrought base metal arch bars for dentate patients with mandibular fractures
• Manufacture of splints for edentulous patients with mandibular fractures

Guidelines

• MHRA (guidance note 10, custom-made dental devices)

Calibration and quality assurance

• Characteristics of measuring equipment and their evaluation
• Definitions of calibration, verification and quality control
• Use of physical quality control

Infection control

• Communicable diseases and microbiological hazards
• Sterilisation and disinfection methods
• Common methods for prevention of cross-infection:
  • hand washing
  • single patient use items
  • disinfection of dental impressions and devices

Activities

• Attend outpatient clinics and/or inpatient ward rounds and/or scientist-led clinics to identify the range of needs of people referred to a reconstructive science service and gain experience of the links between Reconstructive Science, Maxillofacial Surgery and Dental Surgery and other clinical specialisms in the treatment of patients with oral and facial fractures.
• Observe a range of routine procedures undertaken in Reconstructive Science and critically evaluate how these investigations contribute to the diagnosis, management and care of patients and the range of needs of people with disabilities within a typical care pathway for patients referred to the service.
• Attend radiology sessions where patients referred to Reconstructive Science undergo assessment, observing the process to obtain images and discussing the health and safety aspects, including patient safety, with your supervisor.
• Attend a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with oral facial fractures.