Published: 05/09/2019

Head, neck, maxillo-facial and dental surgery

It is expected that this unit can be delivered in most of the non-specialist hospitals that are part of many, if not all, Schools of Anaesthesia. It may not be possible for every trainee to become skilled in all the emergencies described [EN_IS_07], however all trainees are expected to obtain clinical teaching and training in this area of practice, although it is recognised that, availability of chair dental surgery may be limited and this may have to be deferred to the ‘higher’ unit of training but is not mandatory for successful completion of intermediate or higher training in this unit.

Learning outcomes:

  • Build on the knowledge and skills gained in the Basic Level training for ENT, maxillo-facial and dental surgery. Develop knowledge, skills and experience of safe perioperative anaesthetic care of patients undergoing major elective and emergency surgery in these specialty areas
  • To be able to recognise the specific problems encountered with the ‘shared airway’ and manage correctly
  • To have the clinical judgement and skills to organise and manage the anaesthesia for routine ENT, dental and maxillo-facial operating lists involving ASA 1-3 patients requiring minor to intermediate surgery and such patients for emergency surgery without direct supervision  

 Core clinical learning outcome:

  • Deliver safe perioperative anaesthetic care to ASA 1-3 adult patients requiring routine and emergency non-complex minor/intermediate ENT and maxillo-facial surgery [including list management] under distant supervision

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Final examination identified in the FRCA examination blueprint section.

Knowledge

Competence

Description

Assessment

Methods

GMP

EN_IK_01

Explains the special requirements of anaesthesia for all common procedures encountered in specialised head and neck surgery

A,C,E

1,2

EN_IK_02

Recalls/explains the principles of anaesthesia for middle ear surgery, including use of TIVA and hypotensive techniques

A,C,E

1,2

EN_IK_03

Explains the principles of management of anaesthesia for major head and neck surgery and:

  • Recalls/describes the pathophysiological changes and co-morbidities associated with head and neck cancer 
  • Identifies the particular requirements for acute maxillo-facial emergencies e.g. fractured mandible, intra-oral

abscesses and other pathological causes of upper airway obstruction 

A,C,E

1,2

EN_IK_04

Recalls/describes the causes, pathophysiology and management of obstructive sleep apnoea and the surgical procedures used to treat it [Ref; AM_IK_08]

A,C,E

1,2

EN_IK_05

Recalls/describes the characteristics of the lasers used for surgery and the circumstances in which they are used

A,C,E

1,2

EN_IK_06

Recalls the hazards of laser surgery

A,C,E

1,2

EN_IK_07

Recalls/describes the specialised airway techniques used for laser surgery in, or near, the airway

A,C,E

1

EN_IK_08

Describes the safe use of equipment and airways devices used for surgery on and below the vocal chords, including bronchoscopes, Venturi devices and fibre-optic scopes

A,C,E

1,2

EN_IK_09

Explains the use of specialised imaging techniques [CT, MRI] in planning anaesthesia and surgery for head and neck surgery

A,C,E

1

EN_IK_10

Lists the problems associated with chair dental procedures including consent, the specific needs of patients with learning disabilities, Child Protection [Cross reference paediatrics] and the Mental Capacity Act

A,C,E

1,2,3,4

EN_IK_11

Explains the principles of the recognition and appropriate management of acute ENT emergencies, including bleeding tonsils, epiglottis, croup, and inhaled foreign body

A,C,E

1,2,3,4

EN_IK_12

Describes appropriate emergency management of fractures of the face including le Fort fractures and fractures of the mandible

A,C,E

1,2,3,4

EN_IK_13

Describes the emergency management of the obstructed airway including tracheostomy

A,C,E

1,2,3,4

EN_IK_14

Recalls the indications for tracheostomy

A,C,E

1,2

EN_IK_15

Describes the principles of  the care of the tracheostomy

A,C,E

1

EN_IK_16

Recalls/explains the principles of jet ventilation

A,C,E

1

EN_IK_17

Recalls/explains the principles underlying the use of helium

A,C,E

1
Skills

Competence

Description

Assessment

Methods

GMP

EN_IS_01

The learner should develop and modify the skills of pre-operative assessment and optimisation, and the administration of anaesthesia [as identified in basic level training] to include a focus on the special difficulties presented by these surgical subspecialties

A,C

1,2,3,4

EN_IS_02

Demonstrates how to interpret CT and MRI scans of the head and neck [Cross ref non-theatre]

A,C,D

1

EN_IS_03

Demonstrates correct use of a variety of advanced airway devices

A,D

1

EN_IS_04

Demonstrates use of hypotensive techniques where indicated

A,D

1

EN_IS_05

Demonstrates safe anaesthesia/sedation for outpatient dental surgery [cross ref sedation]

A,D

1

EN_IS_06

Demonstrates the safe perioperative anaesthetic management of more complex head, neck and maxillo-facial procedures including, but not limited to:

  • laser surgery 
  • bronchoscopy 
  • surgery on the middle ear 
  • thyroid surgery
  • maxillary and mandibular osteotomies

A,C,D,M

1,2,3,4

EN_IS_07

Demonstrates the safe perioperative anaesthetic management of head, neck, maxillo-facial and dental emergencies including:

  • bleeding tonsil 
  • obstructed upper airway
  • obstructed lower airway
  • mandibular and maxillary fractures

A,C,D,M

1,2,3,4

EN_IS_08

Demonstrates the ability to work with all members of the theatre and surgical teams to manage an operating list with a mixture of ASA 1- 3 non-complex minor/intermediate cases effectively, along with the ability to provide safe perioperative anaesthetic care for the patients 

A,C,M 

1,2,3,4

EN_IS_09

Shows the ability to lead [where appropriate] the theatre team in the perioperative management of patients requiring out of hours minor/intermediate ENT, maxillo-facial and dental surgery, including understanding of when to seek help appropriately

A,C,M

1,2,3,4

EN_IS_10

Demonstrates the specific measures needed to provide appropriate analgesia, and other postoperative care including oxygen therapy, airway monitoring, fluids and anti-emetics in patients following major head, neck, maxillo-facial and dental surgery

A,C,D,M

1,2,3,4