Treatment of electrical burns of the oral and perioral tissues in children

Multidisciplinary care in severe pediatric electrical oral burn

Oral burns in pediatric patient are commonly due to electrical injuries, representing an important reconstructive issue even for functional than esthetic reason. Different classification, surgical management and even oral device were described to allow the best long-term result. In most case a multidisciplinary approach is necessary to achieve a satisfactory outcome. A severe case of pediatric oral burn with germinative teeth damage is presented, describing a multispecialist team approach that guarantee a satisfactory outcome by reconstructive surgery, careful progressive evaluation of dental and soft tissue healing and speech recovery. The use of acellular dermal substitute template within traditional reconstructive surgery had provided a good functional and esthetic result joint to valid preservation of germinative dental element as shown at long-term X-ray evaluation. Intensive rehabilitation speech program has also avoided phonetic impairment in an important speech develop period. It was so evident that the necessity of a multispecialist care in such difficult injury to achieve the best long-term result.

Freeman-Sheldon syndrome: combined surgical and non-surgical approach

BACKGROUND

Many Freeman-Sheldon syndrome patients suffer from extensive microstomia resulting in possible inhibition of dental and skeletal development as well as difficulties in eating, speech and dental hygiene. Oral commissure contraction treatments vary from patient education to complicated surgical and/or prosthetic treatments, but recurrence is often described. This article reports on a combined surgical and non-surgical approach in order to increase maximum mouth opening and maintain the result of the surgery.

TECHNIQUE

The patient underwent bilateral commissuroplasty using 2 rhomboid flaps for each side. After two steps of intraoral and perioral tissue impression taking, a master cast was poured and a retractor was fabricated from thermoplastic material. The patient was encouraged to wear the retractor the entire day and night except at meal times.

RESULTS

After surgery maximum mouth opening was increased from 20 mm to 37 mm and remained the same six months after the surgery. Psychosocial factors were improved and the patient was satisfied with the results of her treatment.

CONCLUSION

The use of bilateral commissuroplasty in combination with this customized dynamic oral commissure retractor may be applicable in other syndromic patients with a small oral commissure and also in patients with circumoral burns.

Oral electrical burns in children-a model of multidisciplinary care

Electrical burns of the mouth are the most common electrical injury in children and can have serious, long-term functional and aesthetic consequences. Presented is a review of the pathogenesis of the associated injury and sequelae, as well as a case report. In the presented case, a multidisciplinary approach was used with input from pediatric dentistry, plastic/burn surgery, and oral and maxillofacial surgery. This collaborative effort and a novel microstomia prevention device produced a superior functional and aesthetic result. Without the aid of a microstomia device, the resultant contracture and associated functional deficits are difficult to release and reconstruct. Thus, proper timing and sequencing of treatment is critical.

An alternative treatment for postburn microstomia treatment: Composite auricular lobule graft for oral comissure reconstruction

Microstomia is one of the most distressing results of burn. In this article, two cases presenting with microstomia following burn injury were revealed. In these patients, perioral and commisure defects due to burn were severe. The commissuroplasties were performed with a composite graft harvested and reshaped from the ear lobule. The oral aperture was evaluated before and after the operation and the patients were followed-up for two years. As a result, the opening was nearly normal without the help of a splint. Functional recovery were satisfactory as the incidence of drooling disappeared. Both patients were satisfied with the end results since their quality of life increased significantly.

A Thirty-Year Review of Oral Appliances Used to Manage Microstomia, 1972 to 2002

Patients who have sustained a facial burn often contend with cosmetic and functional challenges, including microstomia. Many devices have been created by a variety of professionals to provide oral stretching. These devices can be classified as intraoral or extraoral and deliver a stretch either horizontally, vertically, or circumorally. The purpose of this article is to present a comprehensive review of oral-stretching devices.

Oral Burn Contractures in Children

Oral burn contractures in children present major reconstructive problem. Only few reports in literature discussed oral burns in children. Electrical, chemical, and thermal agents are the main causative agents for oral burns. Oral contractures can be classified into anterior, posterior, and total. Anterior contractures are usually caused by electrical burns and involve the oral commissure, lips, anterior buccal sulcus and surrounding mucosa, and anterior tongue. Posterior oral contractures are caused by caustic ingestion and involve the posterior buccal mucosa, posterior tongue, retro-molar area and oro-pharynx. Total oral contractures involve the lips, tongue, oral cavity, and oro-pharyngeal mucosa and are caused by lye caustic ingestion. This report reviews three children; one with posterior, two with total oral cavity contracture. All cases were managed by linear release of scar contracture and skin grafting followed by a prolonged intra-oral splinting with a fixed mouth-block and commissural splint. A successful outcome was observed in all cases.

An intraoral splint for the prevention of microstomia from facial burns

Microstomia may be a disfiguring complication of severe burn injuries of the soft tissues of the face. The constriction of the perioral myocutaneous tissues following such trauma poses several problems and usually necessitates major plastic and reconstructive intervention. A novel technique is described which limited the anticipated constriction of perioral tissues in a 21-year-old female who suffered full skin thickness burns to 65 per cent of her body, including her face, following a self-induced petrol burn.