Firecracker Maxillofacial Injury in a 6-Year-Old Child- A Case Report.

The present case report highlights the management of a 6 years old female child who suffered oral and maxillofacial injury due to explosion of a fire cracker inside the mouth which was managed by primary closure after complete debridement and to prevent the post treatment microstomia, a modified microstomia prevention intraoral prosthetic appliance was given and followed up for 15 months.

[General principles of burn reconstruction]. / Principes généraux de la chirurgie reconstructrice des séquelles de brûlures.

The aims of burn reconstruction should be to preserve, restore, and maintain function and appearance so the patient can recover a social life. Reconstruction surgery is delayed until the scar tissue has fully matured; it occurs generally by 9 to 12 months or more (merits of vitro-pressure test). Exception in presence of severe contracture (growth disturbance, unstable scars, corneal exposure with ectropion, severe microstomia) Occupational and physical therapy, scar management, compressive techniques, psychotherapy are all integral components of burn rehabilitation, but the place of plastic surgeon is fundamental all along the process.

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.

14 year follow-up for a severe electrical burn to mouth and lip: case report.

INTRODUCTION: Electrical burns range from 4 to 7% of the total burn accidents and many of them affect primarily children biting on a live wire. Great confusion exists in the literature about the proper management of electrical burns to the mouth in the acute and late phases. CASE REPORT: 14 year results are shown in a severe electrical burn sustained in a 1 year 2 months old girl, involving 90% of the lips and commissures, tongue, alveolar ridges and teeth (primary central incisors and permanent dental germs). Two weeks after she was out of danger, an active splint expansion device was built and used for 8 months to prevent secondary microstomia. Later a new active splint device was used for a year after lip plastic surgery. At age 13, orthopedics and orthodontics were accomplished with a lip tattoo completed at age 15. CONCLUSION: No matter how good the final esthetic and occlusal results are, prevention is always the best option.

Dynamic commissural splint.

Microstomia, an abnormally small oral orifice, can manifest as a sequela of burns involving the oral and perioral tissues due to contraction of the tissues and hypotonia of the circumoral musculature. Regardless of the etiology, scar contracture results in deformities that produce esthetic and functional impairment. Changes in the circumoral anatomy prevent optimal dental care and maintenance of good oral hygiene. The anatomic changes may detrimentally alter eating, speech, and mandibular motion. Prosthetic treatment involves providing physical resistance to scar contracture by maintaining the oral commissures in their normal relationship by means of a splint. This article describes a method to fabricate a dynamic commissural splint and describes its use in two cases.

The staircase technique for treatment of cancer of the lower lip: a report of 36 cases.

PURPOSE: This article reports the authors' experience with treatment of lower lip cancer using the staircase technique. PATIENTS AND METHODS: Thirty-six patients with stage T1 or T2 cancers of the lower lip were treated. RESULTS: No recurrences were observed during a 6- to 32-month follow-up. All patients showed excellent aesthetic results and no microstomia. CONCLUSIONS: The staircase technique can be used to close defects of up to two thirds of the lower lip. Two bilateral symmetric flaps are used for median defects; 2 bilateral asymmetric flaps are used for paramedian defects greater than 20 mm; and only 1 contralateral flap is required for paramedian defects up to 20 mm.

A review of selected microstomia prevention appliances.

Perioral burns may occur due to electrical, thermal, or chemical agents. The resultant contracture of the facial tissue during healing causes limited oral access, compromised esthetics, and other related problems. This article presents various microstomia prevention appliances used by dentists and hospital burn centers. These appliances reflect different treatment concerns, ease of fabrication, age appropriateness, and cost effectiveness. An understanding of these factors and available appliances will aid the clinician in selecting or developing the best appliance for burn patients.

Results of a modified staircase technique for reconstruction of the lower lip.

Our experience with a modified staircase technique for closure of lower lip defects is reported. The procedure is based on the original technique of Johanson et al. (1974). However, the integrity of the orbicularis oris muscle is respected when advancing lower lip flaps. Twenty patients with squamous cell carcinoma of the lower lip were treated using this modified reconstruction technique. The size of the defects ranged from 30-60% of lower lip width. No recurrences were observed during a 3-year to 5-year follow-up. All patients showed symmetrical lip movement, an adequate buccal sulcus and intact labial commissures. No symptomatic microstomia was seen and the aesthetic results were excellent. The surgical technique is explained in detail. Four types of flap are presented according to the size and location of lip defects. Lower lip defects up to 60% of the lip width can be closed easily, with good aesthetic results. The technique is also applicable to upper lip reconstruction.

Evaluation of a vertical mouth stretching orthosis: two case reports.

Burns around the mouth frequently result in contractures or microstomia. Orthoses used in the past have usually been designed to stretch the mouth horizontally. Finding a comfortable effective way to stretch the mouth vertically proved to be a challenge. A jaw positioner was used for vertical mouth stretching in two case studies and was evaluated for effectiveness of preventing mouth contractures and for comfort, durability, ease of use, adaptability for children, and ease of measuring results. Vertical and horizontal passive range of motion increased with initial use and then was maintained in both patients. The jaw positioner was comfortable and easy to use. This orthosis could be adapted to fit in a child's mouth and was impossible to swallow. Progress was easy to monitor with the numeric scale on the orthosis. Though no single orthosis will be ideal for every oral burn, this jaw positioner is recommended for pediatric and adult patients with extensive circumoral burns who demonstrate fair to good compliance.

Oral electrical burns: etiology, histopathology, and prosthodontic treatment.

Oral electrical burns occur predominantly in young children and may lead to permanent disfigurement. The etiology and histopathology of oral electrical burns are discussed. Prosthodontic treatment options are presented to provide clinical guidelines for the practitioner.

Expanding oral plastic splint for burn patients.

An expanding oral plastic splint for preventing microstomia from deep facial burns is described. This splint adjusts to suit the affected oral angles without the need for taking any impression before fabrication. It is especially suitable for severely injured patients starting from the early period shortly after injury, even if the patient has been intubated. Furthermore the expansion forces can be controlled easily according to the degree of contracture.

Reconstructing the burned face.

The priorities, timing, techniques, and philosophies of reconstruction of the burned face are outlined in this article. Each anatomic area is analyzed, and the appropriate procedure is described.

Splints and accessories following burn reconstruction.

Splints, exercise, traction, and compression garments are commonly accepted methods to minimize disabling scar formation. Although burn rehabilitation treatment has improved over the past 10 years, there is still no overnight cure for scars and contracture. The extent and depth of the burn injury, emotional strength and patience of the burn victim, and support systems available play an important role in scar treatment. Scar contracture is a frustrating complication for the recovering patient and burn team. Surgical reconstruction to correct functional impairment is often needed before wound maturation is complete. Splints are usually part of the postoperative treatment plan. When this is the case, patient understanding, compliance, motivation, and comfort are important to assure splint effectiveness. The treatments reviewed are specific for scar contracture limiting function of the upper body. Although they were presented as treatment of neck, mouth, axilla, and hand contractures, many of the principles and materials can be used after burn reconstruction of the lower extremities. Regardless of the area treated, assessment of patients is important to determine their specific needs in splint design.

Oral commissure expansion prosthesis.

An expansion prosthesis to stretch commissures and fibrotic muscles is often essential for patients recovering from head and neck trauma or burns. The prosthesis is easily made in one appointment using Triad resin and a 7 mm expansion screw. Depending on the frequency of use, varying degrees of opening of the jaws can be obtained. The prosthesis is inexpensive to make and can easily be modified as needed. It is convenient for use because the patient controls the pressure that is applied by the prosthesis.

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.

A technique for construction of dynamic oral commissure retractors.

Microstomia may result from congenital defects, trauma, or surgery. Regardless of the etiology, the scar contracture can result in deformities that produce esthetic and functional disturbances. The literature described the use of static and dynamic commissure retractors. This article describes a technique for constructing commissure retractors from resilient mouth protector material reinforced with stainless steel wire. The tension of the commissure retractors is controlled with elastic bands attached to an orthodontic neck strap. The use of the retractor and the need for careful follow-up are addressed. The dynamic commissure retractors described have been used clinically with success. Research is required to quantify the qualitative and quantitative improvements in reducing microstomia with these retractors.

A mouth splint for severe burns of the head and neck.

An individual mouth splint device that applies continuous or intermittent pressure to stretch commissures and fibrotic muscles in patients treated for microstomia resulting from facial and neck burns is presented. After an individual lip tray is prepared, the method uses the impression and cast of the region of the lips to construct a pink acrylic resin splint. By using the device, split horizontally and activated with a Hyrx screw, an opening of 14 mm can be obtained within 2 weeks. The device is recommended as being easily constructed, inexpensive, almost painlessly inserted, and progressively activated.