Clinical Assessment and Investigation and Planning

Module details

Title

Clinical Assessment and Investigation and Planning

Type

Rotation

Module code

SPE401

Credits

10

Requirement

Compulsory

Aim of this module

This rotation will enable the trainee to gain a greater understanding of the role of other related diagnostic modalities, rehabilitation and therapeutic services such as radiology, psychology and pathology in the diagnosis and treatment of patients referred to Reconstructive Science. This module will give the trainee knowledge and understanding of the interpretation and clinical decision making associated with clinical assessment and investigations in the context of differential diagnosis, together with an understanding of the principles of operation, data acquisition and quality assurance of other diagnostic service modalities. The potential physical and psychological factors affecting patients will be explored and the trainee will be introduced to treatment and support mechanisms, including psychological assessment. An introduction to clinical decision making associated with clinical assessment in the context of patient-centred care and safety, differential diagnosis, and an understanding of the principles of operation, data acquisition and quality assurance of other diagnostic service modalities. Trainees will perform appropriate methods used as part of the overall assessment of patients, ensuring the safety and dignity of patients.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,2	Competency Control infection risks in accordance with departmental protocols.	Action View
# 2	Learning outcome 1,2	Competency Minimise risks and hazards in compliance with health and safety policies.	Action View
# 3	Learning outcome 1,2	Competency Treat patients as individuals and respect their dignity, choice and confidentiality, and provide support to enable them to care for themselves.	Action View
# 4	Learning outcome 1,2	Competency Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.	Action View
# 5	Learning outcome 1,2	Competency Gain informed consent for each procedure.	Action View
# 6	Learning outcome 1,2	Competency Explain each type of procedure to the patient, address any procedure- related questions they may have and provide information on how the patient will be informed of the follow- up processes.	Action View
# 7	Learning outcome 1,2	Competency Make contemporaneous patient records from a range of patients referred to Reconstructive Science.	Action View
# 8	Learning outcome 1,2,3	Competency Work in partnership with healthcare colleagues to promote a multidisciplinary team (MDT) approach to patient care.	Action View
# 9	Learning outcome 2	Competency Assist with obtaining a clinical history using a logical sequence/framework, which might include: brief biography history of presenting complaint past history smoking/alcohol use allergies medication (prescribed and other) family/social history concerns and expectations summarise.	Action View
# 10	Learning outcome 2	Competency Perform a clinical examination on a patient identifying clinical features and relating the clinical features to image data.	Action View
# 11	Learning outcome 2	Competency Recognise abnormalities of the head and neck and raise concerns where appropriate.	Action View
# 12	Learning outcome 3	Competency Identify and classify common craniofacial anomalies.	Action View
# 13	Learning outcome 3	Competency Undertake pre-surgical planning for a simple surgical procedure and analyse your findings.	Action View
# 14	Learning outcome 3	Competency Interpret the data obtained during the clinical assessment and pre- surgical planning for a simple surgical procedure.	Action View
# 15	Learning outcome 3	Competency Plan and manufacture a surgical inter-occlusal wafer.	Action View

Assessments

You must complete:

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

Preparation for patient examination or clinical procedure.	DOPS
Clinical examination of a patient and their defect site.	OCE

Learning outcomes

1. Obtain consent and make contemporaneous patient records from a range of patients referred to Reconstructive Science using a recognised structure and applying the principles of patient-centred care.
2. Perform a clinical examination, identifying clinical features and relating the clinical features to image data, recognising abnormalities of head neck and referring where appropriate.
3. Identify and classify common craniofacial anomalies and complete pre- surgical planning for simple procedures using clinical assessment, image analysis, 3D modelling data and dental casts.

Learning outcomes

1. Describe the principles of patient-centred care that considers the physical, emotional, social, economic and spiritual needs of the person; their response to illness; and the effect of the illness on the ability to meet self- care needs.
2. Discuss the physical and psychological factors associated with altered body image.
3. Describe the psychosocial factors associated with altered body image and the treatments and support mechanisms available for patients with facial deformities, including psychological assessment.
4. Explain and evaluate the application of diagnostic imaging (ionising and non-ionising) used to investigate patients referred to a reconstructive science service.
5. Identify clinical anatomical features and altered anatomy due to congenital, traumatic and neoplastic change.
6. Apply and extend knowledge of the head and neck anatomy to the planning and surgical treatment of facial deformities.
7. Discuss the incidence and aetiology of congenital and acquired craniofacial deformities.
8. Analyse and classify facial deformities using manual and computer-aided analysis techniques.
9. Discuss and justify the selection and validity of analogue and digital planning systems for elective surgery.
10. Describe the pathogenesis of common neoplasms and the structure, behaviour, diagnostic investigations and management of neoplasms of the head, neck and skin.
11. Describe and compare techniques for determining the physical, chemical and genetic characteristics of the tissue.
12. Describe and apply the TNM tumour staging system.
13. Discuss 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.

Indicative content

Physical and psychological factors associated with altered body image

• Psychoanalytic models of body image
• Cognitive behavioural models of body image
• Preoperative, early postoperative, rehabilitation, medium- and longer-term care
• Communication

Application of diagnostic imaging (ionising and non-ionising)

• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Surface data acquisition
• Nuclear medicine
• Positive emission tomography (PET)
• Ultrasound

Anatomy of the Face and Neck Face and scalp

• Bones of the skull, their features and function
• Main cutaneous nerves supplying the face and scalp
• Course of the arteries that supply blood to the face and scalp
• Venous drainage of the face and scalp
• Organisation of the main groups of lymph nodes found in the head and neck
• Main muscles of facial expression, define their attachments and describe the movements they produce
• Layout of the main branches of the facial nerve on the face

The neck

• Triangles of the neck and list the layers of cervical fascia
• Motor and cutaneous components of the cervical plexus
• Gross anatomical relationships of structures within the neck, particularly thyroid gland and digestive tract
• Arteries that supply the thyroid gland

Mouth and tongue

• Main mucosal features of the tongue
• Extrinsic and intrinsic muscles of the tongue; describe the nerve supply and actions of these muscles
• Nerves that carry general sensation and taste sensation from the tongue
• Lymphatic drainage of the tongue

Physiology of the temporomandibular joint

• Anatomy, development and innervation of the joint
• Actions of the various muscles involved in the joint during both movement and at rest
• Reflex control of movements of the joint
• Physiology of the TMJ in relation to the clinical situation

Larynx and phonation

• Named parts of the laryngeal airway
• Intrinsic laryngeal musculature and the actions of these muscles in opening and closing the glottis
• Motor and sensory nerve supply and the lymphatic drainage of the larynx
• Movements of the larynx that occur during swallowing and phonation

Anatomy of swallowing

• Arrangement and subdivisions of the pharynx and their major contents, including muscles, blood supply and innervation
• The soft palate, the pharyngotympanic tube and the oropharyngeal ring of lymphoid tissue
• The stages of swallowing, including the action of the tongue

Protective reflexes of the airway and speech

• Process of swallowing food without it progressing down the airway
• Factors that affect secretion of mucus and describe how it protects the airway
• Why some patients gag during impression taking

Intracranial region

• Boundaries of the intracranial region and the contents of the three cranial fossa
• The organisation of the dura mater and the cranial cavity and identify the foramina or fissures through which these structures pass
• The main arteries and nerves that enter or leave the cranial cavity and identify foramina or fissures through which these structures pass

Cerebellum

• The organisation of the cortex nuclei within the cerebellum
• The nature and course of the afferent and efferent connection of the cerebellum

Cranial nerves

• The 12 pairs of cranial nerves
• The function of and which anatomical structures the facial and trigeminal nerves innervate
• Commonly occurring cranial nerve lesions
• Range of nerve disorders (i.e. Horner’s syndrome, trigeminal neuralgia, ansomia, herpetic infections, Bell’s palsy, hypoglossal lesions)
• Clinical management of a damaged nerve and its repair

Orbit

• Bones that make up the orbital cavity and structures that pass through the superior orbital fissure and through the optic canal
• Structure of the eyelids
• Extra-ocular muscles, their attachments, actions and innervation
• Lacrimal apparatus: lacrimal gland, nasolacrimal sac and nasolacrimal duct
• Sensory and motor limbs of the blink reflex

External and middle ear

• Main contents of the middle ear cavity
• Appearance of the tympanic membrane
• Motor and sensory pathways that travel in the facial nerve

Nasal and paranasal sinuses

• Relationship of the anatomy of the lateral wall of the nose to the paranasal sinuses and nasolacrimal duct
• The function of the nasal and paranasal sinuses
• The important neighbouring structures that may be involved with the spread of sinus disease
• The blood supply of the nose
• Incidence and aetiology of congenital and acquired craniofacial deformities
• Analysis and classification of facial deformities using manual and computer- aided analysis
• Analogue and digital planning systems for elective surgery
• Pathogenesis of common neoplasms
• Structure, behaviour, diagnostic investigations and management of neoplasms of the head, neck and
• Methods used in a pathology department to prepare tissue samples for examination
  • frozen sections
  • paraffin-embedded (permanent) sections
• Techniques for determining the physical, chemical and genetic characteristics of the tissue
• TNM (Tumour, Node, Metastasis) tumour staging system
• Potential routes of transmission of infectious agents in clinical practice
• Mechanisms for the prevention of infection

Scientific principles of decontamination and disinfection/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 a range of outpatient or other healthcare settings that patients referred to a maxillofacial service attend, and discuss the range of communication and clinical skills you observe, evaluating the positive aspects and those areas that could be improved upon.
• Identify a patient referred to the reconstructive science service and, with permission, follow the progress of the patient from the initial consultation, through procedures, follow-up appointment and/or surgery, talk to the patient and discuss their experience and reflect on your learning from this process and how you will apply this in future practice.
• Observe the work undertaken by colleagues working in psychological support services with patients, typically those referred from a reconstructive science service.
• Observe colleagues in pathology receiving, analysing and reporting on tissue samples from patients typically referred to a reconstructive science service.