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Li R, Zheng Y, Fan X, Cao Z, Yue Q, Fan J, Gan C, Jiao H, Liu L. Establishment and validation of a nomogram to predict the neck contracture after skin grafting in burn patients: A multicentre cohort study. Int Wound J 2023; 20:3648-3656. [PMID: 37245866 PMCID: PMC10588345 DOI: 10.1111/iwj.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023] Open
Abstract
Cervical burn contracture is one of the burn contractures with the highest incidence and severity, and there is no effective method to predict the risk of neck contracture. This study aimed to investigate the effect of combined cervicothoracic skin grafting on the risk of neck contracture in burn patients and to develop a nomogram to predict the risk of neck contracture after skin grafting in burn patients. Data from 212 patients with burns who underwent neck skin grafting were collected from three hospitals, and the patients were randomly divided into training and validation sets. Independent predictors were identified through univariate and multivariate logistic regression analyses and incorporated into a prognostic nomogram. Its performance was assessed using the receiver operating characteristic area under the curve, calibration curve, and decision curve analysis. Burn depth, combined cervicothoracic skin grafting, graft thickness, and neck graft size were significantly associated with neck contractures. In the training cohort, the nomogram had an area under the curve of 0.894. The calibration curve and decision curve analysis indicated good clinical applicability of the nomogram. The results were tested using a validation dataset. Combined cervicothoracic skin grafting is an independent risk factor for neck contracture. Our nomogram demonstrated excellent performance in predicting neck contracture risk.
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Affiliation(s)
- Rui Li
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Yangyang Zheng
- Department of General Surgery, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Xijuan Fan
- Department of Plastic SurgeryBeijing Ever Care Medical and Beauty HospitalBeijingChina
| | - Zilong Cao
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Qiang Yue
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Jincai Fan
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Cheng Gan
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Hu Jiao
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Liqiang Liu
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
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Li R, Zheng Y, Fan X, Cao Z, Yue Q, Fan J, Gan C, Jiao H, Liu L. Epidemiology and Predictors for Cervical Burn Scar Contractures: A Multicenter Cohort Study. J Craniofac Surg 2023; 34:1795-1798. [PMID: 37184463 DOI: 10.1097/scs.0000000000009344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 05/16/2023] Open
Abstract
Cervical burn scar contracture (BSC) affects many important neck functions and the patients' quality of life. However, it remains unclear which patients have a higher risk of neck BSCs. This study aimed to describe the epidemiology and identify the independent risks of cervical BSC formation and severity. Clinical and demographic data of 106 patients with burn scars were retrospectively collated and analyzed from 3 different Chinese hospitals between December 2016 and December 2020. Both univariate and multivariate logistic regression analyses were performed to identify the independent risks for BSC formation and severity at 12 months postburn. Lateral flexion was the most common plane of motion (POM) limited by contractures (29.4%), whereas the POM most commonly limited by severe contractures was the extension (24.6%). Most patients with contractures had those in 3 to 4 POMs (72.1%). Neck skin grafting was an independent risk factor for BSC formation, and cervical and cervicothoracic skin grafting were independent risk factors for BSC severity. These results may help to identify high-risk patients with contractures in the early stages of burns to carry out individualized early prevention and treatment.
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Affiliation(s)
- Rui Li
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangyang Zheng
- Department of General Surgery, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xijuan Fan
- Department of Plastic Surgery, Beijing Ever Care Medical and Beauty Hospital, Beijing, China
| | - Zilong Cao
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Yue
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jincai Fan
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Gan
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hu Jiao
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liqiang Liu
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Beck I, Tapking C, Haug V, Nolte S, Böcker A, Stoppe C, Kneser U, Hirche C, Hundeshagen G. Short- and long term hyposmia, hypogeusia, dysphagia and dysphonia after facial burn injury - A prospective matched cohort study. Burns 2023; 49:380-387. [PMID: 35525769 DOI: 10.1016/j.burns.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/03/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Facial burns frequently occur in occupational or household accidents. While dysphagia and dysphonia are known sequelae, little is known about impaired smell and taste after facial burns. METHODS In a prospective observational controlled study, we evaluated hyposmia via the Sniffin' Stick Test (SnS), hypogeusia via a taste strip test, and dysphonia and dysphagia via validated questionnaires acutely and one-year after burn, respectively. A matched control group consisting of a convenience sample of healthy volunteers underwent the same assessments. RESULTS Fifty-five facial burn patients (FB) and 55 healthy controls (CTR) were enrolled. Mean burn size was 11 (IQR: 29) % total body surface area (TBSA); CTR and FB were comparable regarding age, sex and smoking status. Acutely, hyposmia was present in 29% of the FB group (CTR: 9%, p = 0.014) and burn patients scored worse on the SnS than CTR (FB: 10; CTR: 11; IQR: 2; p = 0.013). Hyposmia per SnS correlated with subjective self-assessment. Hyposmia and SnS scores improved over time (FB acute: 10.5 IQR: 2; FB one year: 11; IQR: 2; p = 0.042) and returned to normal at one-year post burn in most patients who completed the study (lost to follow-up: 21 patients). Taste strip scores were comparable between FB and CTR, as was the acute prevalence of dysphagia and dysphonia. CONCLUSION Hyposmia acutely after facial thermal trauma appeared frequently in this study, especially when complicated by inhalation trauma or large TBSA involvement. Of all complete assessments, a fraction of burn patients retained hyposmia after one year while most improved over time to normal. Prevalence of dysphonia, dysphagia and hypogeusia was comparable to healthy controls in this study, perhaps due to overall minor burn severity.
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Affiliation(s)
- Inessa Beck
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Steffen Nolte
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Armed Forces Hospital Ulm, Ulm, Germany
| | - Arne Böcker
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Plastic, Hand and Reconstructive Microsurgery, Hand Trauma and Replantation Center, BG Unfallklinik Frankfurt am Main, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
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Nambi G, Abdelbasset WK, Soliman GS, Alessi AA, Alsalem IN, Ali ZA. Clinical and functional efficacy of gallium-arsenide super pulsed laser therapy on temporo mandibular joint pain with orofacial myalgia following healed unilateral cervicofacial burn - A randomized trial. Burns 2022; 48:404-412. [PMID: 34674896 DOI: 10.1016/j.burns.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cervicofacial burn (CB) is a unique type of burn, involving the lateral part of the face, neck and chest region with significant skin contractures. Temporomandibular joint (TJ) pain and orofacial myalgia (OM) are the major problems in physiotherapy context to treat. Laser is commonly used as an adjunct therapy in painful conditions. However, clinical studies are lacking in investigating the effects of gallium-arsenide (Ga-As) super pulsed laser therapy on temporomandibular joint pain and orofacial myalgia following healed cervicofacial burn patients. OBJECTIVE To investigate the effects of clinical and functional efficacy of Ga-As super pulsed laser therapy on temporomandibular joint pain with orofacial myalgia following healed cervicofacial burn patients. METHODS Through two block random sampling method, the eligible participants were randomized and allocated into active laser (Active-L; n = 18) and placebo laser (Placebo-L; n = 18) groups. The Active-L group received laser treatment and the Placebo-L group received placebo laser effect (inactive laser) with regular physiotherapy care for 3 times in a week for 4 weeks. Primary (pain intensity, pain threshold, pain frequency) and secondary (mouth opening, disability level and quality of life) measures were measured at baseline, after the end 4th week, 8th week and 6 month follow up. RESULTS Baseline subjective and clinical attributes show homogenous presentation among the study groups (p > 0.05). After four weeks of treatment, and at the end of 6 months follow up, the pain intensity, 2.9 (CI 95% 2.80-3.00), pain threshold 19.2 (CI 95% -30.4 to -7.9), pain frequency 3.4 (CI 95% 3.14-3.65), mouth opening, -16.0 (CI 95%-16.5 to -15.4), disability level 11.3 (CI 95%11.14-11.45), and quality of life -31.7 (CI 95%-37.1 to -26.2) showed more improvement (p < 0.001) in Active-L group than Placebo-L group. CONCLUSION The reports of this study proved that, four weeks active laser therapy with regular physiotherapy care has an ideal treatment protocol for temporomandibular joint pain with orofacial myalgia following healed cervicofacial burn. This study also provided a new knowledge for physiotherapists in the field of temporomandibular joint pain rehabilitation.
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Affiliation(s)
- Gopal Nambi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia; Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Gaber S Soliman
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al-Qurayyat, Jouf University, Saudi Arabia
| | - Ahmed A Alessi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ibrahim N Alsalem
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Zeinab A Ali
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Wang BB, Patel KF, Wolfe AE, Wiechman S, McMullen K, Gibran NS, Kowalske K, Meyer WJ, Kazis LE, Ryan CM, Schneider JC. Adolescents with and without head and neck burns: comparison of long-term outcomes in the burn model system national database. Burns 2022; 48:40-50. [PMID: 33975762 PMCID: PMC8526620 DOI: 10.1016/j.burns.2021.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Facial burns account for persistent differences in psychosocial functioning in adult burn survivors. Although adolescent burn survivors experience myriad chronic sequelae, little is known about the effect of facial injuries. This study examines differences in long-term outcomes with and without head and neck involvement. METHODS Data collected for 392 burn survivors between 14-17.9 years of age from the Burn Model System National Database (2006-2015) were analyzed. Comparisons were made between two groups based on presence of a head and neck burn (H&N) using the following patient reported outcome measures: Satisfaction with Appearance Scale, Satisfaction with Life Scale, Community Integration Questionnaire, and Short Form-12 Health Survey at 6, 12, and 24 months after injury. Regression analyses were used to assess association between outcome measures and H&N group at 12-months. RESULTS The H&N group had more extensive burns, had longer hospital stays, were more likely to be burned by fire/flame and were more likely to be Hispanic compared to the non-H&N group. Regression analysis found that H&N burn status was associated with worse SWAP scores. No significant associations were found between H&N burn status and other outcome measures. CONCLUSIONS Adolescents with H&N burn status showed significantly worse satisfaction with appearance at 12-months after injury. Future research should examine interventions to help improve body image and coping for adolescent burn survivors with head and neck burns.
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Affiliation(s)
| | - Khushbu F. Patel
- Shriners Hospitals for Children – Boston, Boston, MA United States,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Audrey E. Wolfe
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Nicole S. Gibran
- Department of Surgery, University of Washington Harborview, Seattle, WA, United States
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Walter J. Meyer
- Department of Psychiatry, University of Texas Medical Branch, Galveston, TX, United States
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Colleen M. Ryan
- Shriners Hospitals for Children – Boston, Boston, MA United States,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States,Corresponding author. (J.C. Schneider)
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The addition of respiratory muscle strength training to facilitate swallow and pulmonary rehabilitation following massive tissue loss and severe deconditioning: A case series. Aust Crit Care 2021; 35:210-216. [PMID: 33902987 DOI: 10.1016/j.aucc.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/23/2021] [Accepted: 03/21/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Impaired respiratory and swallow function in patients with intensive care unit-acquired deconditioning, such as associated with massive tissue loss, is not uncommon and can require prolonged rehabilitation. AIM The aim of the study was to examine the effect of combined inspiratory and expiratory respiratory muscle strength training (RMST) on respiratory and swallow function in two critical care patients with marked deconditioning after massive tissue loss. METHODS Case 1 was a 19-year-old male patient with 80% body surface area burns; case 2 was a 45-year-old man with group A streptococcus myositis necessitating quadruple amputation. Both required prolonged intensive care and mechanical ventilation. Both received routine intensive pulmonary and swallow rehabilitation before the trial; however, chronic aspiration and poor secretion clearance remained. At 25 and 26 weeks after initial injury, RMST was performed using EMST150 (expiratory) and Threshold IMT (inspiratory) devices, respectively. At baseline and throughout treatment, data collected included peak expiratory flow (PEF), anthropometry measures, aspiration risk (Penetration-Aspiration Scale [PAS]), pharyngeal clearance (Yale Pharyngeal Residue Scale), secretions (New Zealand Secretion Scale [NZSS]), and functional diet (Functional Oral Intake Scale [FOIS]) via endoscopy. RESULTS/DISCUSSION At baseline, the PEF score of case 1 was 41% (predicted age-height norm) and the PEF score of case 2 was 14%, indicating severe expiratory compromise. Both had extreme energy requirements (3300 kcal/day; 3500 kcal/day). The baseline swallowing scores of case 1 and 2 were as follows: PAS, 8 and 8; Yale, 9 and 10; NZSS, 4 and 7; and FOIS, 1 and 1, respectively, indicating profound dysphagia. At week 3 of 7 of RMST, swallow function improved to allow both to commence oral intake, followed by tracheostomy decannulation. At weeks 10 and 11, full dysphagia resolution was achieved (FOIS = 7; PAS = 1, Yale = 2, NZSS = 0), with PEF at 70% and 48% predicted respectively. Both patients continued RMST, and at discharge from the acute facility, PEF was 84% and 80% predicted respectively. CONCLUSION The addition of RMST assisted swallow and pulmonary rehabilitation in both cases and was clinically viable to deliver. Controlled validation trials are now required.
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Magnani DM, Sassi FC, Vana LPM, Fontana C, Furquim de Andrade CR. Orofacial rehabilitation after severe orofacial and neck burn: Experience in a Brazilian burn reference centre. Burns 2020; 47:439-446. [PMID: 32826096 DOI: 10.1016/j.burns.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To quantify the benefits of a functional oral rehabilitation program for impairment caused by full thickness orofacial and neck burns, comparing the effects of early and late intervention. METHODS An observational cross-sectional study was conducted in a burn reference center over a two-year period. Patients with full thickness orofacial and neck burns were divided in two groups: Group 1 was composed by 14 patients who began the rehabilitation program 3-12 months after the burn injury; Group 2 was composed by 15 patients who began the rehabilitation program more than 12 months after the burn injury. Treatment was based on current strategies of non-surgical exercises for orofacial contracture management. Outcome measurements included an oral motor clinical evaluation and the assessment of the mandibular range of movement. RESULTS The functional rehabilitation program was effective in reestablishing the oral motor functions (i.e deficits reduced to approximately 15% when compared to the optimal possible scores) and in restoring horizontal mouth opening dimensions, with more than 70% of the patients presenting measurements within the expected normal limits at the end of treatment. Our results did not indicate differences in performance between the group of patients in neither set of assessments, i.e. pre and post treatment (p > 0.05). CONCLUSION The results of this study indicate that non-invasive orofacial contracture management is effective for patients with orofacial and neck burns, including those with long term sequelae.
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Affiliation(s)
- Dicarla Motta Magnani
- Division of Orofacial Myology, Hospital das Clínicas, School of Medicine, University of São Paulo, Rua Dr. Ovídeo Pires de Campos, 186, São Paulo, CEP: 05403-010 SP, Brazil.
| | - Fernanda Chiarion Sassi
- Department of Physiotherapy, Speech-language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, SP CEP: 05360-160, Brazil.
| | - Luiz Philipe Molina Vana
- Division of Plastic Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255 - 8º andar sala 8128, São Paulo, SP CEP: 05403-900, Brazil.
| | - Carlos Fontana
- Division of Plastic Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255 - 8º andar sala 8128, São Paulo, SP CEP: 05403-900, Brazil.
| | - Claudia Regina Furquim de Andrade
- Department of Physiotherapy, Speech-language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, SP CEP: 05360-160, Brazil.
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Nambi G, Abdelbasset WK. Efficacy of Maitland joint mobilization technique on pain intensity, mouth opening, functional limitation, kinesiophobia, sleep quality and quality of life in temporomandibular joint dysfunction following bilateral cervicofacial burns. Burns 2020; 46:1880-1888. [PMID: 32586613 DOI: 10.1016/j.burns.2020.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bilateral cervicofacial burn contracture initially affects facial expressions and later affects tempero mandibular joint (TMJ) function of the patient. It further tightens the ligaments and capsules around the TMJ and leads to tempero mandibular dysfunction. The consequences of temporomandibular joint dysfunction will be pain, limitation of mouth opening, functional disability and poor quality of life (Qol). However, studies examining the efficacy of Maitland joint mobilization technique in this population are lacking. OBJECTIVES To find the short term effects of Maitland joint mobilization technique on pain, mouth opening, functional limitation, kinesiophobia, sleep quality and Quality of life in tempero mandibular joint dysfunction following bilateral cervicofacial burns. METHODS Thirty subjects with temporomandibular joint dysfunction following cervicofacial burn (N=30) were allocated to Maitland joint mobilization group (n=15) and home based training group (n=15) randomly to receive Maitland joint mobilization technique and home based training for 4 weeks. All the participants received ultrasound therapy as common treatment. Primary (Numeric Pain Rating Scale - NPRS, maximal mouth opening - MMO & Tempero mandibular disability index - TDI) and secondary (Tampa Scale of Kinesiophobia - TSK-17, Sleep quality questionnaire - SSQ & Global Rating of Change - GRC) outcome measures were measured at baseline, after four weeks and three months follow up. Repeated measures of ANOVA and independent t test were performed for analyzing the dependent variables in both groups. RESULTS Baseline demographic characters and study variables show homogenous distribution between the groups (p>0.05). Four weeks following different training protocols Maitland joint mobilization group shows more significant changes in pain intensity, mouth opening, functional limitation, kinesiophobia, sleep quality and Qol than home based training group (p≤0.05). Also Maitland joint mobilization group show significant improvement in study variables than home based training group (p≤0.05) at three months follow up. CONCLUSION Both groups improved over time, however, differences between the groups were noticed small. However, physiotherapy management which includes Maitland joint mobilization technique and therapeutic exercise program has an effective strategy in the treatment of tempero mandibular joint dysfunction following cervicofacial burns.
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Affiliation(s)
- Gopal Nambi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia.
| | - Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
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Influence of Inhalation Injury on Incidence, Clinical Profile and Recovery Pattern of Dysphagia Following Burn Injury. Dysphagia 2020; 35:968-977. [PMID: 32103328 PMCID: PMC7223884 DOI: 10.1007/s00455-020-10098-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/17/2020] [Indexed: 11/26/2022]
Abstract
Inhalation injury is predictive of dysphagia post burns; however, the nature of dysphagia associated with inhalation burns is not well understood. This study describes the clinical profile and recovery pattern of swallowing following inhalation burn injury. All patients admitted 2008–2017 with confirmed inhalation burns on laryngoscopy and managed by speech-language pathology (SLP) were included. Initial dysphagia presentation and dysphagia recovery pattern were documented using the FOIS. Co-presence of dysphonia was determined clinically and rated present/absent. Persistent laryngeal/pharyngeal injury at 6 months was documented using laryngoscopy. Data were compared to published data from a large adult burn cohort. All patients with confirmed inhalation burns during the study period received SLP input, enabling review of 38 patients (68% male; m = 40.8 years). Percent Total Body Surface Area burn ranged 1–90%, 100% had head and neck burns, 97% required mechanical ventilation (mean 9.4 days), 18% required tracheostomy and 100% had dysphonia. Comparing to non-inhalation burn patients, the inhalation cohort had significantly (p < 0.01) higher dysphagia incidence (89.47% vs 5.6%); more with severe dysphagia at presentation (78.9% vs 1.7%); increased duration to initiate oral intake (m = 24.69 vs 0.089 days); longer duration of enteral feeding (m = 45.03 vs 1.96 days); and longer duration to resolution of dysphagia (m = 29.79 vs 1.67 days). Persistent laryngeal pathology was present in 47.37% at 6 months. This study shows dysphagia incidence in burn patients with inhalation injury is 16 times greater than for those without inhalation injury. Laryngeal pathology due to inhalation injury increases dysphagia severity and duration to dysphagia recovery.
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Joo SY, Lee SY, Cho YS, Seo CH. Balloon Catheter Dilatation for Treatment of a Patient With Cricopharyngeal Dysfunction After Thermal Burn Injury. J Burn Care Res 2019; 40:710-713. [PMID: 30953060 DOI: 10.1093/jbcr/irz044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Deglutition disorder is a clinical symptom that has been associated with inhalation and cutaneous thermal burn injuries. Deglutition disorder is present in approximately 11% of patients with burn injury and is known to persist for weeks to months postinjury. Here, we report a case of deglutition disorder associated with cricopharyngeal dysfunction in a patient with thermal burn injury. Two patients presented with deglutition disorder lasting for several weeks after thermal injury. Clinically, it manifested as combined liquid and solid food dysphagia. The findings of videofluoroscopic swallow study (VFSS) were poor relaxation of the pharyngoesophageal sphincter (PES), decreased elevation of the laryngohyoid, and inadequate pharyngeal contraction. The PES was dilated with a 20-mm expansion balloon catheter multiple times. The symptoms of deglutition disorder were relieved immediately after the procedure. Balloon catheter dilatation was performed four times at 1- to 2-week intervals. Follow-up VFSS showed that poor relaxation of the PES was improved. The VFSS showed no recurrence at the 3-month follow-up. We found that balloon catheter dilatation for treatment of a patient with cricopharyngeal dysfunction after thermal burn injury was effective, ease of use, and safe.
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Affiliation(s)
- So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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11
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Dysphagia in the burn patient: Experience in a National Burn Reference Centre. Burns 2019; 45:1172-1181. [DOI: 10.1016/j.burns.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/30/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
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Magnani DM, Sassi FC, Vana LPM, Andrade CRFD. Correlação entre escalas de avaliação da cicatrização e as alterações miofuncionais orofaciais em pacientes com queimaduras de cabeça e pescoço. Codas 2019; 31:e20180238. [DOI: 10.1590/2317-1782/20182018238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/13/2018] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Verificar a correlação entre duas escalas para avaliação das cicatrizes pós-queimaduras com as alterações miofuncionais orofaciais em pacientes queimados. Método Participaram do estudo 16 adultos com sequelas de queimaduras de terceiro grau em cabeça e pescoço. As etapas de coleta de dados envolveram: aplicação das escalas de avaliação da cicatrização Patient and Observer Scar Assessment Scales (POSAS) e Vancouver Scar Scale, aplicação da Avaliação Miofuncional Orofacial com Escores Expandidos (AMIOFE-E) e avaliação da mobilidade mandibular. Resultados Os resultados indicaram correlação negativa moderada entre os itens de deglutição, respiração, escore total de funções e escore total na AMIOFE-E e as escalas de cicatriz, indicando que, quanto mais grave a pontuação nessas escalas, menor a pontuação nos itens do AMIOFE-E (indicativo de maior alteração). Não foram observadas correlações entre os itens da avaliação clínica da motricidade orofacial e a escala de gravidade da cicatriz preenchida pelos pacientes. Conclusão Os resultados do presente estudo sugerem que existe uma correlação entre a gravidade da cicatriz de pacientes queimados, medida por meio de escalas médicas, e as alterações miofuncionais orofaciais. Pacientes que apresentarem pontuação indicativa de cicatrizes patológicas em região de cabeça e pescoço devem ser imediatamente encaminhados para avaliação miofuncional orofacial.
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Magnani DM, Sassi FC, Andrade CRFD. Reabilitação motora orofacial em queimaduras em cabeça e pescoço: uma revisão sistemática de literatura. ACTA ACUST UNITED AC 2019. [DOI: 10.1590/2317-6431-2018-2077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
RESUMO Objetivos Investigar estudos sobre o tratamento das queimaduras em cabeça e pescoço, nas diversas áreas da saúde envolvidas na assistência a queimados (médica, enfermagem, fonoaudiologia, fisioterapia e terapia ocupacional), avaliando a eficácia das técnicas empregadas, principalmente no que se refere à reabilitação da funcionalidade da musculatura em cabeça e pescoço. Estratégia de pesquisa Os artigos foram selecionados por meio da base de dados PubMed, utilizando os descritores “burn and face and speech-language pathology”, “burn and face and speech language”, “burn and face and rehabilitation”, “burn and face and myofunctional rehabilitation”, “burn and face and myofunctional therapy”, “nonsurgical and scar and management”, “burn and face and nonsurgical” e “burn and face and scar and management”. Critérios de seleção Foram incluídos artigos que investigaram os tratamentos das queimaduras em cabeça e pescoço, associados à reabilitação da funcionalidade da musculatura em cabeça e pescoço, utilizando exercícios musculares e/ou terapias manuais. Resultados A maioria dos tratamentos descritos apresentou efeitos benéficos para pacientes com queimaduras. Foi observada grande variabilidade da metodologia adotada para a aplicação e verificação dos efeitos dos tratamentos. Conclusão Apesar do crescente número de pesquisas, ainda não existe consenso quanto à melhor técnica terapêutica e ao real benefício de cada uma delas. Existe uma grande diversidade nos protocolos de tratamento, sendo que um número pequeno de estudos de tratamento visa a funcionalidade do sistema miofuncional orofacial. A maioria dos estudos tem, como foco, atividades motoras isoladas, que visam à mobilidade mandibular.
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Chan CH, Yang SF, Yeh HW, Yeh YT, Wang YH, Teng YH, Yeh CB. Risk of pneumonia in patients with burn injury: a population-based cohort study. Clin Epidemiol 2018; 10:1083-1091. [PMID: 30214313 PMCID: PMC6121749 DOI: 10.2147/clep.s172980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Burns are the main cause of accidental injury, and pneumonia is a common respiratory disease in humans. Aim The purpose of this study was to investigate the relationship between burn injury and pneumonia. Patients and methods A nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. We identified and enrolled 2,893 subjects with burn injury, who were individually matched to 2,893 subjects in the comparison group by using the propensity score. Furthermore, we used a self-controlled case-series design to estimate the temporal association between burn injury and pneumonia. Results Exposure to burn injury revealed a higher risk of pneumonia than that to non-burn injury within 1 year. The Cox proportional hazards model revealed that, compared with the non-burn injury, burn injury yielded a 2.39-fold (95% CI=1.44-3.96) increase in risk of pneumonia. The exposure period of burn injury within 30 days showed 2.76-fold increase in risk of pneumonia (95% CI=1.44-3.96) compared with that in the baseline period. Conclusion Burn injury was associated with a significant increased risk of pneumonia, especially occurring within 30 days.
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Affiliation(s)
- Chi-Ho Chan
- Department of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Ying-Tung Yeh
- Graduate School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, Republic of China.,School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, Republic of China.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ying-Hock Teng
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China, .,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China,
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China, .,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China,
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Akita S, Hayashida K, Takaki S, Kawakami Y, Oyama T, Ohjimi H. The neck burn scar contracture: a concept of effective treatment. BURNS & TRAUMA 2017; 5:22. [PMID: 28717655 PMCID: PMC5508764 DOI: 10.1186/s41038-017-0086-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/07/2017] [Indexed: 02/07/2023]
Abstract
A neck scar contracture can severely and negatively affect the function of mastication, phonic, or breathing and result in neck pain and issues with esthetics. The best way is of course to avoid such contracture by means of non-surgical treatment such as use of a growth factor. The basic fibroblastic growth factor is clinically well proven in decreasing scar formation and improving healing. There are numerous reconstructive methods for neck contracture, especially when the lesions are relatively limited in part of the neck. However, a very severe and full circumferential scar contracture requires extensive reconstruction. The thin groin flap is one of the answers and well matches with the tissue texture and maintains the flexibility. Even with extensive burns and delayed reconstructions due to resuscitation first, the groin area is well preserved and can be safely harvested by dual vasculature systems of the superficial circumflex iliac artery and superficial epigastric artery, which warrant more reliability compared to the perforator flaps in this area. More demanding and stringent forms of the neck burn scar contracture are the sequelae of radiation. A radiation burn or radiation injury can be progressing and hard to heal. Adipose-derived stem cells can reverse the scar contracture as the surrounding tissue is softened and can accelerate wound healing. In this review, different types of neck burn scar contracture and reconstructive methods are summarized, including innovative use of bFGF and ADSCs in the management of difficult wound healing and scar contracture.
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Affiliation(s)
- Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan ku, Fukuoka, 8140180 Japan
| | - Kenji Hayashida
- Section of Plastic Surgery, School of Medicine, Shimane University, Shimane, Japan
| | - Satoshi Takaki
- Department of Plastic Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshihisa Kawakami
- Department of Plastic Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takuto Oyama
- Department of Plastic Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroyuki Ohjimi
- Department of Plastic Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
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