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LETTER TO EDITOR
Year : 2018  |  Volume : 26  |  Issue : 1  |  Page : 106-107

Prevention of microstomia in patients having perioral burns


Department of Plastic and Reconstructive Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India

Date of Web Publication11-Mar-2019

Correspondence Address:
Dr. Raghav Shrotriya
Department of Plastic and Reconstructive Surgery, Opp Ward 16, 2nd Floor, Gynec Wing, Seth G S Medical College and KEM Hospital, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.206702

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How to cite this article:
Puri V, Shrotriya R, Ghubade N, Kumail S, Mayekar S, Patil D. Prevention of microstomia in patients having perioral burns. Indian J Burns 2018;26:106-7

How to cite this URL:
Puri V, Shrotriya R, Ghubade N, Kumail S, Mayekar S, Patil D. Prevention of microstomia in patients having perioral burns. Indian J Burns [serial online] 2018 [cited 2019 Sep 18];26:106-7. Available from: http://www.ijburns.com/text.asp?2018/26/1/106/206702



Facial burns are a common cause of morbidity in burn patients. Deep burns over lip and oral commissures heal with scarring resulting in microstomia which leads to eating difficulties, hygiene problems, and facial disfigurement frequently requiring surgical correction. Hence, the prevention of microstomia becomes an important part of management of perioral burns. Here, the authors discuss their experience in the prevention of microstomia in burn patients with perioral involvement.

Various modalities have been used in our wards for prevention of microstomia following lip and oral commissural burns. Asking the patients to eat uncut fruits such as apple or guava [Figure 1] prevents the formation of contracture along with providing essential micronutrients and increasing the patient involvement in the treatment. Objective measurement of mouth opening (Inter-incisor distance) using scale helps to motivate the patients and provides them with a goal to catch up with, making the exercise more interesting and also providing positive feedback.[1]
Figure 1: Asking the patient to eat an uncut apple

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In these patients of facial burns, collagen sheets are applied as acute care dressing.[2] Once dry and stuck, not being stretchable, they impair mobility of the cheek and cause resistance to opening the mouth. Hence, we make a cut on the edge of the collagen sheets at the angle of the mouth. This frees the surfaces to have good healing without impairing mouth opening.

Dried lips in postburn patients [3] also cause pain and bleeding on being stretched and can be an impediment for the patients in attempting mouth opening. Adequate lubrication of lips using emollients such as liquid paraffin or glycerin avoids this problem and softening of the lips aids in increasing compliance for mouth opening exercises.

Application of splints is a well-standardized technique for prevention of development of contractures. Historically, many different types of microstomia prevention appliances have been described by various authors in literature, both static [4],[5] and dynamic,[6] each having their own pros and cons. These should maintain symmetrical position of oral commissures and stabilize the orbicularis oris muscle by means of two-point fixation. For this purpose, the authors have been using the C-type lip and cheek retractor made of plastic which is used for dental and maxillofacial procedures to stretch the lip and cheek [[Figure 2], right upper]. It is a static appliance which stretches the lips in both horizontal and vertical dimensions by the virtue of its innate elasticity. It is self-retaining, cheap, easily available in various sizes and does not require specialized fabrication. The splint is applied throughout the day and is removed intermittently while eating and during exercise. Wet gauze is placed over the open part of mouth to prevent drying. Patients who come with late burns are given especially fabricated thermoplastic splints which can be gradually molded and stretched [Figure 2].
Figure 2: Use of specially made head-mounted aquaplast splint for microstomia prevention ((left upper); C-type lip and cheek retractor used in maxillofacial procedures, being used for microstomia prevention (right upper); Use of specially made self-retaining aquaplast splint for microstomia prevention (left lower); Various types of splints used for microstomia prevention in our unit (right lower)

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To summarize, all the patients with facial and peri-oral burns who have undergone treatment in our burn unit are started on a multipronged protocol as follows: (1) mouth opening exercises; (2) objective measurement of inter-incisor distance; (3) taking large bites of uncut fruits while eating; 4) making slits at edges while applying collagen; (5) adequate lubrication of lips; and (6) application of microstomia splints along with a wet gauze covering the open part of mouth to prevent dryness. Patient compliance has been found to be good along with active participation of patients and their families. With diligent and persistent use of these techniques and active monitoring for development of microstomia, the authors have been successful in avoiding microstomia requiring surgical correction in all the patients. Perioral burns add significantly to morbidity of burn patients and preventive strategies need to be implemented early in the treatment of these patients. This can be done by active participation of patients, and continued follow-up care with splintage and surgery, when required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Procter F. Rehabilitation of the burn patient. Indian J Plast Surg 2010;43:S101-13.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Waghmare M, Shah H, Tiwari C, Makhija D, Desale J, Dwivedi P. Collagen dressings in the management of partial thickness pediatric burns: Our experience. Indian J Burns 2016;24:53-7.  Back to cited text no. 2
  [Full text]  
3.
Goel A, Shrivastava P. Post-burn scars and scar contractures. Indian J Plast Surg 2010;43:S63-71.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Carlow DL, Conine TA, Stevenson-Moore P. Static orthoses for the management of microstomia. J Rehabil Res Dev 1987;24:35-42.  Back to cited text no. 4
    
5.
Heinle JA, Kealey GP, Cram AE, Hartford CE. The microstomia prevention appliance: 14 years of clinical experience. J Burn Care Rehabil 1988;9:90-1.  Back to cited text no. 5
    
6.
Conine TA, Carlow DL, Stevenson-Moore P. Dynamic orthoses for the management of microstomia. J Rehabil Res Dev 1987;24:43-8.  Back to cited text no. 6
    


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