We are UHB: Carwyn Harries, Trainee Maxillofacial Prosthetist

University Hospitals Birmingham NHS Foundation Trust runs Good Hope, Heartlands, Queen Elizabeth and Solihull hospitals, the Birmingham Chest Clinic, and Solihull community services.

I went to Cardiff Metropolitan University to study dental technology. I had an interest in dental and I like working with my hands, so I thought dental technology would be perfect. But I was missing the interaction with people. Traditionally, as a dental technician, you don't tend to see the patient unless you become a clinical dental technician, which is further training. During my final year of university, I was introduced to maxillofacial prosthetics. My current services manager came to my university, we met, and I knew that's what I wanted to do. So, I started training in Swansea and was there for a couple of years through the Covid-19 pandemic. Following that, I was given the opportunity to complete my Masters here in Birmingham and started at UHB in March last year.

I had no idea maxillofacial prosthetist was a career, but when I saw the job satisfaction you get, I knew it was for me. You have a lot of interaction with the patient. You can see the results right in front of you, and you know if it's been successful. You have more freedom to explore and people in our profession have different techniques; using different instruments materials. We aim to get the same result at the end, but everyone has their own approach. In dental technology, we studied everything from dentures, orthodontic work, crowns, and bridges. But, the maxillofacial side of things is a postgraduate taught program, and we do everything from facial prosthetics to custom deep buried implants. More recently, the profession has expanded in what we do. For example, we make digits and we're moving into orthopaedic work as well. The traditional name for the title is maxillofacial prosthetist, but recognition by the Academy of Healthcare Science has led us to being redefined as reconstructive scientists.

In the prosthetics department, we have our own benches and we use a range of materials. We predominantly work with wax and silicone, matching to our patient’s skin colour. We balance that manufacturing time with clinic time; seeing a patient and taking impressions of any sort of defects that they may have. We attend multidisciplinary meetings, where we'll work with the surgeons and nurses seeing patients with issues like infection of implants, to new patients that are undergoing treatment or future patients. We have got some very talented people in the maxillofacial laboratory, especially within the facial prosthetics. It is life changing for our patients and their families; our goal is to make something that they can use with confidence and get their quality of life back.

Some of the appointments can be quite emotional and it can sometimes be challenging to manage the expectations of our patients. Sometimes, things that have been surgically removed can never be replaced, but we do our best to replicate aesthetically what they have lost. We also attend theatre sessions, witnessing our planned virtual surgical planning take place. We have three patient cohorts.

We have trauma patients, who have experienced something like a road traffic accident or an attack from an animal. Then we have oncology patients, who have had surgery, and we are trying to restore any defects that have happened because of that. And finally, we have the congenital side of things. This is people born without something, which is most commonly ears.

The patient’s pathway can be long, especially the cancer treatment pathway, but we are very involved in their treatment planning. Appointments themselves can be long, some much longer than others. That's just the nature of the job we are doing. We work predominantly with wax in the clinic where we're trying a prosthesis on, just to get the shape and fit perfect for the patient. Here is where we can see the prosthetic aesthetics start to take shape, working with the patient to achieve the best result. Sometimes the colour of the prosthesis is slightly off, which is challenging; there are little things we can do to adjust this, such as extrinsic colouring.?If the patient has had surgery, there can be anatomical changes through the healing process, and this can result in an ill-fitting prosthesis. Weight loss or gain can also impact on the fitting of a patient’s prosthesis. Unfortunately, sometimes implants can fail with patients, and we may resort to alternative methods of retention for their prosthesis.

There are less than 150 maxillofacial prosthetists registered in the UK. It's a very small number and there's an aging population within our profession, retiring in the next 5-10 years. There's a huge demand for people to get training and to qualify into the profession. Birmingham is one of the centre hubs for the profession and we are the biggest in the UK, in terms of patient volume we see and the specialties that we deal with.

It’s not just facial prosthetics that we do. We branch out into all sorts of different departments, like burns and plastics, neurosurgery and ears, nose, and throat (ENT). We also work with different hospitals, such as the Birmingham Children's Hospital and The Royal Orthopaedic Hospital. What we do is part of a very emotional journey for our patients. We see everyone from babies who are a few months old and teenagers, to patients in their 90s. It's a diverse range of patients and I've learnt a lot about myself in terms of dealing with different patients and their expectations. It’s a very rewarding job.

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