Customised titanium implants for orofacial reconstruction

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on customised titanium implants for orofacial reconstruction.

The guidance was considered for reassessment in January 2011 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.

Description

The use of customised titanium orofacial implants is indicated for facial reconstruction following excision of orofacial tumours, in cases of severe orofacial trauma, and for congenital facial anomalies.

Stereoscopic lithography is used to create functional anatomic models in resin from which customised titanium implants can be produced using computer-controlled milling. In orofacial reconstruction, customised titanium implants of the mandible and maxilla (anatomical facsimiles) are made.

In the technique described by Peckitt, the oral and nasal titanium surfaces are exposed and the dentition is reconstructed using an overdenture which sits directly on the metal base. In this way, dentures can be made on the implant rather than cast from an impression and thus a one-step procedure without the need for free flaps is achieved.

Similarly, in craniofacial surgery, the use of computer aided design and stereolithography facilitates the production of complex geometric implants to replace facial features with very precise implant/bone margins (0.25mm to the border of the defect). Implants are stabilized using titanium screws. This technique has also been used in orbital reconstruction to correct bony orbital defects following tumour excisions.

OPCS4.6 Code(s):

The production of a customised titanium implant for orofacial reconstruction is outside of the scope of OPCS-4. The procedure to fix the implant to the patient for the orofacial reconstruction can be coded using OPCS-4 codes depending on which facial bones were reconstructed.

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

Details

Contact details:

Links:

	IPG28 Exposed customised titanium implant for orofacial reconstruction: guidance	17 December 2003
	IPG28 Exposed customised titanium implant for orofacial reconstruction: guidance (web format)	08 February 2011
	IPG28 Exposed customised titanium implant for orofacial reconstruction: understanding NICE guidance	17 December 2003
	IPG28 Mewnblaniadau titaniwm gweladwy wedi'u saernïo ar gyfer adlunio'r wyneb: deall canllawiau NICE	12 May 2009
	IPG28 Exposed customised titanium implant for orofacial reconstruction: distribution list	17 December 2003
	Consent - procedures for which the benefits and risks are uncertain	27 November 2003
	Interventional procedures consultation document - customised titanium implants in orofacial reconstruction	05 August 2003
	Overview of customised titanium implants in orofacial reconstruction	05 August 2003