Maxillofacial Prosthetists and Technologists
The final item of business today is a members’ business debate on motion S4M-07793, in the name of Linda Fabiani, on celebrating maxillofacial prosthetists and technologists.
Motion debated,
That the Parliament congratulates Michael O’Neil, a maxillofacial technologist from East Kilbride, on winning the top prize from the Institute of Maxillofacial Prosthetists and Technologists, The Wim de Ruiter Delft Plate Award, for research that he undertook to gain his masters degree; understands that Michael pioneered a technique that enhances surgical results for patients who undergo jaw surgery; notes that maxillofacial prosthetics is the clinical healthcare science that deals with specialist rehabilitation of patients requiring treatment after, for example, traumatic injury, cancer surgery or defects from birth causing malformation, and recognises the work of maxillofacial prosthetists and technologists in Scotland and what it considers the immense benefits of this surgery to those who require it.
17:05
I thank all those attending the debate tonight and all those who signed the motion.
Until I read in my local paper, the East Kilbride News, about the achievement of East Kilbride resident Michael O’Neil, the term “maxillofacial prosthetistry” was not one that slipped easily from my tongue—it still doesn’t, as members will appreciate as the debate proceeds. Indeed, it had not registered in my thoughts.
I did a bit of research, and my interest was kindled. When I visited the west of Scotland regional maxillofacial prosthetics service at Glasgow’s Southern general hospital, I was absolutely fascinated to learn about the work that is carried out by eight maxillofacial prosthetists, who work between the Southern general and Glasgow royal infirmary.
The service is responsible for the provision of treatment for patients with a disfigurement in the head and neck region. The deformity can be trauma related or congenital, or it can be the result of cancer surgery. The work ranges from the fitting of simple surgical plates, which are used to aid healing, to the recontouring of a patient’s skull after trauma using a custom-fabricated titanium cranial implant. The laboratory runs prosthetic clinics and fabricates custom-made noses, ears, indwelling eyes and orbital prostheses for patients who have lost part of their facial contour through trauma, cancer or congenital deformity.
I am grateful to Michael O’Neil, Fraser Walker and their colleagues, who provided an in-depth tour and presentation during my visit to the Southern general’s max fax lab—which I have decided is much easier to say. I am glad to welcome some of the team to the Parliament this evening. The presentation detailed how far maxillofacial technology has come, from post-war prosthetics—which, I mention for interest, were generally attached to spectacles—to new, life-like silicone prosthetics, which can be attached using magnets or by fixing them to bone. During the visit, Michael and Fraser demonstrated by showing personal cases where maxillofacial technology has been used to correct abnormalities in the jaw or skull.
It was clear to me that the work is life changing. Small or major enhancements to appearance promote confidence and self-esteem, and they help to remove the stigma that so often unjustifiably applies to those who look different to what we deem to be normal.
I was very much struck by the personal bond between practitioner and client. Sometimes, it is built up over years. There is a closeness that, in many cases, is beyond that of the general practitioner or dental practitioner, because of the respect that is given to the clients. In return, there is an absolute trust granted by the client to the practitioner. That caring relationship can be demonstrated by Michael O’Neil’s charity work to raise funds for related causes.
I was also very much struck by the cutting-edge research and technology at the heart of the discipline, and that brings me specifically to East Kilbride’s own Michael O’Neil.
A maxillofacial prosthetist, Michael O’Neil from the Southern general hospital scooped a prestigious award recently at an international conference. Michael received his Wim de Ruiter Delft plate award for pioneering a technique that enhances surgical results for patients who undergo jaw surgery operations. His technique involves pre-planning the operation on 3D models of the patient’s skull that have correctly proportioned teeth.
The technique has been greatly successful in the correction of facial asymmetries and for difficult craniofacial operations. It allows pre-planning work to be done alongside head and neck cancer surgeons, which can greatly cut down operation time.
Using a computerised tomography scan, digital models can be created that allow for careful planning of the patient’s operation. The use of those models, together with 3D physical models of the tumoured site, allows large bone plates to be prepared with location clips to enable accurate placement of bone grafts that have been taken from another part of the patient’s anatomy. That breakthrough has helped to reduce operation time and has made reconstructive bone grafting more accurate.
I thank the Presiding Officer for allowing me to use a prop in the debate. I was very honoured to receive a miniature version of a skull that has been used for the technique. I know that the boys in the company, in particular, will be fascinated to learn that it was produced on a 3D printer. I have christened it wee Mikey—I should say that I have done so in honour of Michael O’Neil, just in case our minister, Michael Matheson, takes it the wrong way.
There is a great deal more that I could say about this work, but time prohibits me from doing so. I know that many of my colleagues would be as fascinated as I am by the work of the team in Scotland, so I hope that many will attend when I arrange an information session in our Parliament in the new year.
I have some concerns that I would like to express. There is no specific training for maxillofacial prosthetists and technologists in Scotland. Currently there are 14 qualified maxillofacial prosthetists in Scotland, but in six years’ time there will be a 25 per cent reduction in that number because of retirement. The lack of training and discrepancies in pay structure make it difficult to attract maxillofacial prosthetists and technologists to Scotland.
Because of the low number of prosthetists who are required, it may be that it is not practical to form an exclusively Scottish education programme, but imaginative thinking and recognition of a service that is vital to many people and which has such potential—as is demonstrated by the work that is being carried out by Michael O’Neil, Fraser Walker and their colleagues—can surely reach a solution.
I hope that the minister will consider those points; I will write in much greater detail. I suggest that he should consider visiting the unit to speak directly to those who deliver the service and perhaps some of those who receive it. I am sure that he would find that as fascinating as I did.
17:13
I thank Linda Fabiani for securing the debate and, like her, would like to welcome to the Parliament her guests from the field of maxillofacial prosthetics, as well as those who have benefited from their work; I hope that they have enjoyed their day so far and that they are enjoying the debate.
It is clear that the work of maxillofacial prosthetists and technologists can be life changing. As Linda Fabiani said, they work to reconstruct the face after accident or disease. Those who work in the maxillofacial departments of hospitals across the country assist burns victims, cancer patients and many others who need treatment for the disfigurement of the head and neck region. In Glasgow, we know that there have often been specific reasons why such treatment has been required.
The west of Scotland regional maxillofacial prosthetics service operates from two laboratories—one is at the Southern general and the other is at Glasgow royal infirmary. It is responsible for providing a full range of highly specialist technical and prosthetic services to the west of Scotland and Forth valley, as well as to other referring authorities nationally and internationally. I look forward to visiting the unit in the near future.
The department is internationally recognised, not just for Michael O’Neil’s groundbreaking work with 3D printing, which Linda Fabiani highlighted in such an interesting way. One of his colleagues in the service was also presented with an award at the same conference in Inverness earlier this year. I am delighted that George Payne from Glasgow royal infirmary is in the gallery. He was presented with the Mount Vernon award, which recognises outstanding clinical practice—although I suspect that John Mason thinks that it has something to do with him.
George is currently the principal maxillofacial prosthetist based at the Glasgow royal infirmary, providing a prosthesis service to a large number of plastic and ear, nose and throat surgeons. That involves the fabrication of all forms of facial and body prostheses, including burns therapy appliances. After almost 40 years of working in the west of Scotland maxillofacial prosthesis service, developing invaluable skills and expertise along the way, George Payne can be held up as an example of outstanding excellence in his field.
It is testament to the strength of medical research in Scotland that NHS Scotland practitioners are continually being awarded for their research excellence and expertise across a wide variety of work in the national health service. I have recently been working with a local constituency group to support ME sufferers in Glasgow under the NHS, and have been struck by the practitioner research coming out of that field. I hope that it will be as useful to ME sufferers as Michael O’Neil’s research will be to those who require maxillofacial prosthesis.
That excellence is fostered through health research fellowships initiated by the Scottish Government in March 2011. The fellowships are intended to allow clinical staff to develop a research career alongside their clinical duties by funding protected time for research activities. Some of the areas for study in those three-year fellowships include optimising treatment for patients with cardiac disease, improving outcomes for people who have dementia, developing personalised medicine for women who have ovarian cancer, and improving the management of children who have inflammatory bowel disease. It is hoped that the scheme, which has its first fellows about halfway through their first three-year placement, will continue to encourage a culture within the NHS that recognises research as a vital and important part of healthcare that contributes to improvements in patient care.
It is great to be able to speak in a debate that helps to highlight just how much research talent Scotland has to offer across such a wide variety of skills and sectors, particularly in a field such as this, which can make such a huge difference to the lives of those who are treated. Long may it continue, and I hope that Michael O’Neil and George Payne continue with their groundbreaking work for many years to come.
17:16
Although I congratulate Linda Fabiani on initiating the debate, I suspect that we are discussing an area in which most of us had to do some research prior to the debate. Despite my medical background, I am not particularly familiar with this field of expertise. Indeed, as a result of modern technology, it is achieving outcomes that would have been unbelievable when I first came across the specialty as a medical student and young doctor.
We have all read in newspapers of individuals who have sustained horrendous facial injuries in, for example, car accidents, and the previous assumption would have been that the individual involved would simply have had to accept their fate and, to put it bluntly, get on with life. However, advances in the field of maxillofacial surgery and the collaboration of a multidisciplinary team of experts mean that a person is no longer forced to endure the rest of his or her existence with life-changing facial scars or other disfigurements as the result of an accident, congenital defect, or cancer surgery. There has been an increase in the number of stories of individuals who have lost features such as their nose or an eye undergoing skilled and painstaking surgery to give them realistic fabricated replacements, allowing them to re-enter society more confidently and helping them to overcome the psychological traumas of their experiences.
This area of medical science and technology has been one of the great success stories of our time. Although the history of prosthesis stretches back to ancient Egyptian, Greek, and Roman civilisations, it was not until the last century when prosthetics as a recognised medical field came of age. The first world war saw a huge increase in the demand for prosthetics. It was no longer the preserve of the wealthy but necessitated by the introduction of industrialised weaponry such as machine guns, which left many men horrifically scarred.
Maxillofacial prosthetics is part of that growing branch of surgery that deals with the disfigurement of the head and neck region and that, although not life-saving, can totally transform the lives of those so afflicted, giving them the confidence to mix with other people and get back to a more normal life. One person who always comes to my mind when I think about transformation after a maxillofacial trauma is army veteran Simon Weston, who was so badly burned and disfigured in the Falklands war, and who now does so much through his charitable efforts to help other people who have experienced similar traumatic events.
In reading for this debate, I was particularly struck by the moving story of a 16-year-old American girl who was accidentally blasted in the face by drunk friends playing with a stolen shotgun. Although she miraculously survived, she was left blind and horrifically disfigured. That brave young lady went on to marry and have a baby boy 11 years after the accident, but fear of her appearance frightening her child led her to wear a face mask at all times to cover the gaping hole where her eyes and nose once were.
Her life changed after she underwent pioneering maxillofacial surgery, which prepared her remaining bone structure to allow a prosthetic face that was designed on photographs which were taken before the accident, with features that were aged to reflect the passage of time, to be snapped on and off. Although she will never again be able to see and she has lost for ever any sense of smell, the maxillofacial surgeon gave her the confidence to show her son her new face.
The example that I have given is an extreme case, but the key word that I want to highlight is “confidence”. The gaining of confidence extends to all people who feel renewed by maxillofacial surgery, such as those who were born with a cleft palate, those who need a jaw realignment, and those who are deformed by cancer surgery or trauma.
The motion rightly pays tribute to the many prosthetists and technologists who work in the field, and particularly to Michael O’Neil from East Kilbride, who, as we have heard, pioneered a technique to enhance the surgical results for patients who undergo jaw surgery. That led to his winning the Wim de Ruiter Delft plate award. I am happy to add my congratulations to Mr O’Neil on that magnificent achievement, and I once again thank Linda Fabiani for the debate.
17:21
I, too, thank Linda Fabiani for bringing the debate to the chamber.
As other members have done, I put on record my congratulations to Michael O’Neil on winning the Wim de Ruiter Delft plate award from the Institute of Maxillofacial Prosthetists and Technologists. I thought that I knew how to say “maxillofacial prosthetists”, but every member has said it differently, which has somewhat undermined my confidence. I will use the word “confidence” again.
I also congratulate the wider team at the Southern general hospital and Glasgow royal infirmary. Michael O’Neil won the award, but there is a variety of experts in the department who excel in the field.
I wanted to speak in the debate for a number of reasons. One is that, as a Glasgow member of the Scottish Parliament, I wanted to recognise and acknowledge the very best practice in the world—the world-leading practice—that is clearly evident there. I am also the deputy convener of the Health and Sport Committee, and am interested in finding out more about the issue. Perhaps with my Glasgow colleague James Dornan and the minister, I hope, we can go along and see in action the good work at the Southern general hospital.
I also have a personal reason that I had forgotten about for wanting to speak in the debate. As a daft laddie in Dundee around 20 years ago, I took a tumble. I questioned my relationship with alcohol on that particular day, but I took a tumble nevertheless and was left with a fairly dramatic hole in my chin. As I was regaining consciousness, the doctors who were attending to me were debating whether they should try to reconstruct the hole in my chin or put it to the plastic specialist in Dundee. Fortunately for me, they put it to the plastic specialist. The difference that that made to the scar that I was left with on my chin was quite dramatic. It is now pretty minimal.
Nanette Milne mentioned confidence. I am not comparing that trivial event with the more dramatic life-changing events that other members have mentioned, but it meant that I had a small beard for a year or so afterwards because I was embarrassed by my scar, which undermined my self-confidence. If something as trivial as that can undermine a young man’s self-confidence, I can only imagine the impact that a full facial reconstruction can have. We have to look at the major technological advances, but we should not forget that little, minor miracles are performed every day of the week. As a young man who was making my way in the world, what happened made a huge difference to my quality of life. I have no idea who the plastic surgeon was, but I thank them greatly, as the work made a difference to my life.
I want to quote a colleague, Ken Andrew. He does not work in Glasgow, but he is involved in prosthetics—not facial prosthetics but limb prosthetics. I asked him what he had heard about maxillofacial prosthetisists—I said that wrongly; never mind. He dropped me an email before the debate in which he mentioned the great expertise and the advances that there have been, but he also said a couple of things that were particularly powerful:
“The impact these technicians have on the improved well being of individuals that have suffered devastating injury through trauma and disease is very hard to imagine ... Max fax technicians are true artisans with the very best of them possessing genuine artistic talent.”
We are not talking just about the high-end stuff, but about the attention to minor details that those experts provide.
I have run over my time, Presiding Officer, and I thank you for your patience in listening. As well as thanking Linda Fabiani for bringing the debate to the chamber, I thank Michael O’Neil and his team at the Southern, as well as the GRI, for all the work that they do.
17:25
I congratulate Linda Fabiani on securing the debate, and I add my congratulations to Michael O’Neil on winning the award that is very much the subject of the debate.
It is important that we in Scotland nurture and develop our talent. We often lead the way in the United Kingdom for research, which means that we attract a greater share of research funding than our population would indicate, and that is down to the talents of people such as Michael O’Neil, who go ahead blazing a trail and winning awards. There are many other researchers who do likewise in Scotland, so the debate is about them as well.
We often underestimate the importance of facial reconstruction, seeing it as something that is done for aesthetic purposes rather than medical imperatives, but that point of view underestimates the impact that a change to our face can have on us, both mentally and physically. Bob Doris eloquently spoke of his own experience of having an injury that he considered relatively minor and the impact that it had on him. It is hard for us to imagine waking up in the morning and looking in the mirror and the face that looks back at us not being the one that we recognise as our own. That must have a huge impact on people—on their sense of self as well as on their mental health.
At the point when facial transplants were being pioneered, there was a lot of news coverage about it, which talked about the amount of counselling that a transplant recipient would require, much more than if they were getting a heart or any other organ. That is because how we look is so much part of us. We do not see a heart or a kidney, but we do see our own face, and that tells us who we are, so we need to appreciate fully the importance of how we look to our sense of self.
Neither do we fully appreciate how we use our face to communicate with others, not just by speaking as we are tonight—although speech can be affected by injuries around the mouth, breakages of bones or cancer treatment—but by the non-spoken communication that we use our face for, which can be absolutely lost if we require a lot of surgery. Changes to the structure of our face can also stop us from eating, which impacts on the rest of our body and on our nutritional intake. Although that can be overcome by tube feeding and the like, it does not take into account the pleasure of eating and of taste and how important that is to us.
The ability to reconstruct a face damaged by an accident or disease can give somebody back the sense of themselves, as well as their ability to communicate and to enjoy the senses that we all take for granted. That is why I am pleased to support the motion, which brings those issues to the attention of the Parliament and pays tribute to the people who carry out that work. I hope that it will also raise awareness of the profession, so that more people will be willing to get involved and to fill the skills gap that Linda Fabiani was talking about.
17:29
I begin, like others, by offering my congratulations to Linda Fabiani on securing time for the debate, and I offer my personal congratulations to Michael O’Neil on his award for pioneering a technique that will enhance surgical results for patients who have undergone jaw surgery. I am more than happy to take up Linda Fabiani’s suggestion and visit the service to learn more about the important work that it undertakes. Michael O’Neil’s award is a recognition of the important work that is being done in the developing field of maxillofacial prosthetics, particularly at the west of Scotland regional maxillofacial prosthetics service.
I am sure that Michael will recognise that it is also appropriate for me to congratulate George Payne from Glasgow royal infirmary, as James Dornan did, on the work that he has undertaken and on receiving the Mount Vernon award for outstanding clinical or technical practice. Both awards reflect the importance of the specific research of certain individuals but also the wider pioneering work in the field that is taking place within NHS Scotland. We are both grateful for and proud of that.
The west of Scotland regional maxillofacial prosthetics service is responsible for treating patients with a disfigurement of the head and neck region. A wide variety of work is done in the service, from surgical plates that are used to aid healing to the recontouring of a patient’s skull after trauma. As Linda Fabiani mentioned, the laboratory runs prosthetics clinics and fabricates custom-made noses, ears, indwelling eyes and orbital prostheses for patients who have lost part of their facial contour through trauma, cancer or congenital deformity.
The field of maxillofacial prosthetics and the technology have seen some significant developments in a fairly short period of time. We are seeing increasingly sophisticated technologies such as 3D modelling to enable the accurate modelling and construction of prosthetic replacements for mouth, jaw and facial reconstructive surgery.
Having undertaken research as part of his master’s degree, Michael O’Neil received his award for pioneering a technique whereby surgical results can be enhanced for patients who undergo jaw surgery operations. His technique involves pre-planning the operation on a 3D model of the patient’s skull that has correctly proportioned teeth. The technique involves taking a direct impression of the patient’s dentition, casting it in dental plaster and then replacing the inaccurate dentition of the 3D skull model with the accurate plaster dentition taken from the patient.
The technique is an excellent example of how technology can have a positive impact on patient care and the outcomes for the patient. As Linda Fabiani highlighted, it has helped to reduce operation times and made reconstructive bone grafting much more accurate.
I want to touch briefly on the restorative benefits of the research. It offers significant benefits to people who have lost part of their facial contour through trauma, cancer or congenital deformity. Such a loss is likely to have a serious impact on the person’s self-esteem, as several members said, and their ability to fulfil their potential in our society. Reconstructive surgery brings enormous benefits in improving a person’s outlook and self-confidence. As Linda Fabiani’s motion states, the technology enhances treatment and improves outcomes for patients. It is right that we recognise that in the Parliament.
I also want to highlight some of the wider issues. The motion gives me an opportunity to highlight some of the issues around oral cancer here in Scotland. Although cancers of the mouth are relatively rare, more than 400 cases are still diagnosed in Scotland each year.
It is also more common in men, although rates among women are on the rise. Although the causes are unknown, risk factors are smoking and excessive consumption of alcohol. A study in 2011 estimated that more than half of mouth and throat cancers in the United Kingdom are associated with and caused by smoking. It is important that we keep that in mind when we are looking at preventative approaches to dealing with such issues.
I will reflect briefly on the role of NHS dental services in the prevention of oral cancer. Dental teams are in a unique position to detect oral cancer at its early stages, when we know that it is easier to treat and the outlook is better for the patient. Early diagnosis and treatment can increase a patient’s chances of survival from below 50 per cent to 90 per cent. As well as the fact that we have free NHS dental examinations, I report that registration rates among adults are at their highest level. As at September 2013, a total of 81.6 per cent of adults are registered with a NHS dentist. The equivalent figure in September 2007 was 48.6 per cent.
I return to the motion and the need for the Scottish Parliament to recognise the important work in maxillofacial prosthetics. Although prevention has a role with regard to oral cancer, unfortunately such treatment will always be needed. It is therefore important that we encourage development in this field. The field has an exciting future in which technology and research, as we have heard, can make a difference to the quality of people’s lives. Advances such as the ones that we have heard mentioned represent hope for patients in need of reconstructive surgery of the mouth, jaw or face. I have no doubt that members will be inspired by the work undertaken by Michael O’Neil and his colleagues and will recognise that that work demonstrates the significant advances that are being made in this technological field here in Scotland.
Meeting closed at 17:37.