Oral Surgery (Facial Pain) Service Specificatin Service Cmmissiner Lead Prvider Lead Perid 2. Oral Surgery Facial Pain (SBCH Ref N. SS_046) 1. Purpse 1.1 Aims T prvide a Cnsultant-led specialist diagnstic, advisry and secndary and tertiary care treatment service fr referred patients with chrnic facial pain. 1.2 Evidence Base Facial pain may arise frm dental, facial, systemic and referred cnditins and is ften chrnic. Differential diagnsis is difficult and management may be lng-term. 1.3 General Overview The management f chrnic facial pain is an integral cmpnent f the specialty f Oral Surgery. Aspects f this cnditin may be handled by ral and maxillfacial surgery but management within the primary care sectr is difficult. Cnditins referred include: Neurpathic facial pain cnditins (trigeminal neuralgia, glsspharyngeal neuralgia) Tempr-mandibular jint disrders Oral Dysasthaesias and atypical facial pain and atypical ndntalgia Referred pain frm varius rigins (sinus, salivary glands, intracranial etc.) Vascular headaches (facial migrainus neuralgia, tempral arteritis) Treatment may be nn-surgical r surgical. 1.4 Objectives T effectively and efficiently manage and treat all apprpriately referred patients. 1.5 Expected Outcmes Curing the pain and its cause r at least adequate management t allw return t wrk and nrmal scial activities. 2. Service Scpe 2.1 Service Descriptin This is essentially an ut-patient service, with sme treatment being undertaken under lcal anaesthesia and sedatin. Differential diagnsis may be difficult but treatment mdalities include: Reassurance, explanatin and cunselling. Nn-surgical treatment Self-help jaw exercises Muth splints Referral fr physitherapy, hypntherapy (carried ut by in-huse specialist), psychtherapy Drug therapy: Anticnvulsants Muscle relaxants Antidepressants Btulinum txin
Surgical treatment: Arthrcentesis under sedatin Manipulatin under sedatin 2.2 Accessibility/acceptability Patients are referred directly t the service by a primary care practitiner, a cnsultant clleague r ther clinical services within the Hspital. 2.3 Whle System Relatinships The service prvisin requires clse wrking with ther clinical specialties within the hspital, particularly Restrative Dentistry and with nn-pharmaclgical relaxatin techniques. 2.4 Interdependencies Other clinical specialty areas. The maxillfacial surgical unit at City Hspital. Medical Practitiners. 2.5 Relevant netwrks and screening prgrammes The chrnic pain team based at Selly Oak Hspital. 3. Service Delivery 3.1 Service mdel This is a Cnsultant-led utpatient assessment and treatment service. Management f referred cnditins is ften lng-term. 3.2 Care Pathways All pathways are initiated by a primary and secndary care referral. dependant n the assessed treatment needs. Pathways will vary, 4. Referral, Access and Acceptance Criteria 4.1 Gegraphic cverage/bundaries Like all Dental Hspital clinical services this is a reginal service but a majrity f referrals will cme frm a lcal catchment. 4.2 Lcatin(s) f Service Delivery Birmingham Dental Hspital within the Department f Oral Surgery (2 nd Flr). 4.3 Days/Hurs f peratin 9.00am-5.00pm Mnday Friday plus sme evening clinics. 4.4 Referral criteria & surces Fr a referral t be accepted it shuld: Include all apprpriate demgraphic infrmatin Give the reasn fr referral with an indicatin as t why this cannt be managed in the primary care setting Prvide relevant dental, medical and scial histry Enclse recent relevant radigraphs. 4.5 Referral rute Primary r secndary care prviders refer directly t a named cnsultant r t the Department
f Oral Surgery. Urgent referrals may be made ver the phne. 4.6 Exclusin criteria Patients wuld nt be accepted fr treatment if their treatment needs are within the cmpetence f a primary care practitiner subject t the need t prvide a range f training experience. 4.7 Respnse time & detail and priritisatin Natinal targets apply. Urgent referrals will be priritised. 5. Transfer f and Discharge frm Care Obligatins The patient will be referred back t the primary care practitiner at the end f the treatment episde. 6. Self-Care and Patient and Carer Infrmatin Patients are given verbal and written infrmatin prir t and after treatment t ensure infrmed cnsent and apprpriate pst-perative care. 7. Quality Requirements Perfrmance Indicatr Quality Indicatr Threshld Methd f Measurement Cnsequence f breach Perfrmance & Prductivity 8. Activity 8.1 Activity Perfrmance Indicatrs Threshld Methd f measurement Cnsequence f breach 8.2 Activity Plan 8.3 Capacity Review 9. Prices & Csts
9.1 Price Basis f Cntract Natinal Tariff plus Market Frces Factr Nn-Tariff Price (cst per case/cst and vlume/blck/ther)* Unit f Measurement Price Threshlds Expected Annual Cntract Value Ttal