Oral maxillo-facial, head and neck surgery

For GPs

Appointments

Appointments and referrals can be made by you or your GP via The Electronic Referral Service (e-RS) or CAS, or by ‘Yellow Boards’ direct from the wards.

Waiting times

The average waiting time for the maxillo-facial outpatient clinics is:

• for cancer cases up to 2 weeks
• for routine appointments: up to 2½ months.

For Dentists

Referral  Criteria Update

The Homerton Maxillofacial Surgery Department is committed to providing specialist oral surgery services to patients requiring complex care. However, we have noted an increase in inappropriate Tier 1 referrals for simple extractions that should be managed in primary care.

As per NHS England guidance and your GDS contract/PDS Agreement, NHS providers and performers are expected to carry out extractions of teeth and retained roots that fall within their competence. The patient should ONLY be referred if they present with special difficulties that lie outside the competence of a GDP.

What We Do Not Accept (Tier 1 Procedures):

• extractions of fully erupted teeth with favourable root formation
• simple retained roots that are accessible
• routine extractions in medically fit patients (ASA I-II)
• third molars that are fully erupted and not in close proximity to the inferior dental canal

What We Do Accept:

• failed extractions with documented attempt (please send post-extraction radiograph)
• patients with severe dental anxiety requiring sedation/GA (with completed anxiety assessment)
• teeth with abnormal root morphology (demonstrated radiographically)
• impacted teeth requiring bone removal and surgical division
• teeth with significant cystic changes requiring histological analysis
• extractions with high risk of damage to anatomical structures
• patients with severe medical complications as outlined in guidelines13

 All referrals must include high-quality radiographs showing the entire tooth. Failure to include these may result in rejection and delay in patient care.

If you feel unable to perform a procedure that is within the scope of general practice, please consider:

• seeking support from colleagues within your practice
• attending continuing professional development courses to improve skills
• contacting our department by telephone for advice before referring

Please consider referral to IMOS/ Community dental services for the following:

• failed extractions with documented attempt (please send post-extraction radiograph)
• ASA1/2 patients with severe dental anxiety requiring sedation (with completed anxiety assessment)
• teeth with abnormal root morphology (demonstrated radiographically)

 We are implementing a comprehensive vetting process to ensure appropriate use of our specialist services and to maintain timely access for patients requiring complex care or cancer pathway treatment. Inappropriate referrals will be rejected and returned to the referring practitioner.

 For further information on improving extraction skills, Health Education England provides regular hands-on courses for dentists.

Thank you for your understanding and cooperation in improving the oral surgery care pathway.

Cancer Referral

Visit the  Healthy London.org  website for more information on cancer referrals.

Services at Homerton Hospital

• Head and neck cancer service under the support of the Royal London Hospital Head and Neck Cancer team, following the NICE guidance of a multidisciplinary approach.

• Oral medicine including the diagnosis and management of conditions of the lining of the mouth such as ulcers, lichen planus and thrush.

• Salivary gland disease such as inflammatory diseases and benign and malignant tumours.

• Skin surgery which includes surgery of benign and malignant lesions. We have combined dermatology-maxillofacial clinics for prompt management of skin cancer referrals with a multi-disciplinary approach.

• Facial pain - diagnosis and initial treatment.

• Dentoalveolar/Oral surgery which is surgery of the tooth-bearing part of the jaws. This includes impacted teeth, complex tooth extractions, cysts and lesions of the lining of the mouth and management of dental infection. Priority is given to patients requiring surgical extraction of teeth including wisdom teeth, and those with more complex dento-alveolar problems such as cysts and other types of jaw pathology. Treatment is carried out under local anaesthetic, intravenous sedation and general anaesthetic for those where this is deemed necessary.

Head and Neck Clinic

Initially, patients have a clinical assessment when seen in clinic. This is followed by an ultrasound guided fine needle aspiration (FNA) under the care of a dedicated consultant radiologist. Patients are then seen again in order to discuss the results of the FNA and a personalised treatment plan is put in place should further treatment is required. A follow up appointment is given between 5 and 10 working days.

All suspicious cases are discussed in the multidisciplinary team meeting with a group of experts specialising in this area. Further specialised investigations may be required urgently to help with treatment planning. The tests may include:

• CT scan
• MRI scanning
• Biopsy.

Where to come for the neck lump/oral and maxillofacial surgery outpatient appointment

You will be asked to attend the outpatients department which is situated on the ground floor near the main entrance of the hospital.
Paediatric patients need to come to the Starlight Ward, next to the Fertility Department.

Who can refer?

Your referral will be fast tracked to the cancer referral office to our neck lump and thyroid clinic if your GP or dentist finds a neck or thyroid mass. As mentioned above you will initially have the ultrasound investigation, FNA if needed and then be seen in clinic for examination and discussion of the results. We aim to see patients within 2 weeks of referral. If an ultrasound appointment cannot be provided on the same visit another appointment is usually arranged within a week.

Where to come for the necklump/oral and maxillofacial surgery outpatient appointment

You will be asked to attend the outpatients department which is situated on the ground floor near the main enyrance to the hospital.

Paediatric patients need to come to the Starlight ward, next to the Fertility department.

Clinic times

Please allow a minimum 2-3 hours for your appointment.

What to expect in this clinic

The majority of neck and thyroid masses are not cancerous (i.e. benign). If a suspicious area is noted the team will provide relevant detailed information before proceeding to other investigations. Neck and thyroid cancers may originate from different tissues within the body, which may require treatment from specialties with whom we work closely with.  Whenever a referral is required we aim to ensure that the referral takes place in the shortest possible time. The initial investigations are carried out at Homerton University Hospital however the treatment is provided at St Bartholomew's Hospital which is now part of Barts Health NHS Trust.

How to contact us

To change or cancel your appointment contact the outpatient department on 020 8510 5544

 

Routine investigations

• Blood test: assess your general state of health

• Plain X-ray of the face: X-ray to produces images of the dense tissues inside the body such as bone

• Ultrasound scan is an investigation which uses sound waves to help build a picture of inside the body. There is no radiation involved and it very quick.

• Fine Needle Aspiration (FNA) is a procedure where a fine needle is inserted into the neck mass to take a sample of cells or fluid, from the mass, for microscopic analysis

• Magnetic Resonance Imaging (MRI) scan uses a strong magnetic field to build a picture of the inside of the body instead of X-rays. The scan is helps to show soft tissue masses more clearly.