Management of Extensive Facial Burns in the Intensive Care Unit

Abstract

Perioral facial burns have a high propensity to formation of microstomia and numerous prosthetic devices have been described that can be used postoperatively to address this problem. We introduce a novel device, the Whiston Buccal Prosthesis, which is used intraoperatively and in the early postoperative period and it acts as a surgical aid to prevent or curtail microstomia, as well as to address other problems associated with facial burns. Our device has an overall 4-fold purpose; 1) it acts as a commissural and circumoral retractor, 2) as a means of counter-pressure during excision of burn eschar, 3) counter-pressure for the graft after its placement, and 4) for access to the mouth to maintain oral hygiene. It has been used on 3 patients who have benefited from all or some of the above uses. We have used this device in 3 patients thus far. One died 2 months after her operation but received benefit in the daily maintenance of oral hygiene and also the skin grafts. The other 2 patients were young adults, 19 and 20 years old at the time of injury, who after a 3-year follow-up were discharged not having required any further surgical intervention for microstomia. The Whiston Buccal Prostheses were used for a length of time between 1 and 3 months. Although limited objective evidence exists for our device, subjectively we have seen value intraoperatively, in the prevention of microstomia, the maintenance of oral hygiene, and maintenance of grafts.

Dental management of patients with microstomia. A review of the literature and update on the treatment.

“…The Whiston device is used for 1 or 3 months. Although there is only limited objective evidence for such device, it has been effective in preventing microstomia, in maintaining oral hygiene and in the maintenance of grafts 35 .…”

“…Sofos et al 35 developed a new device called Whiston device used during surgery and in the early postoperative period. It acts as a surgical aid to prevent or reduce microstomia and to deal with other problems associated with facial burns.…”