Rehabilitation of Speech and Swallowing After Burns Reconstructive Surgery of the Lips and Nose

Abstract

Rehabilitation of speech and swallowing postburns reconstructive surgery has not been previously described in detail in the literature. Severe facial burn injury requiring subsequent reconstructive surgery may result in complications including circumoral contracture and aesthetic and functional irregularities. These complications may manifest as facial and labial sensation deficits, poor oral access for intubation and oral/dental hygiene, and inadequate oral competence causing chronic drooling and poor articulation. This report describes the physical rehabilitation of a patient with full-thickness burns to the nose, lips, mouth, and chin following electrical burn injury. The severity of injury sustained placed the patient at high risk for microstomia, dysphagia, and speech disorder. A multidisciplinary team approach was used to coordinate the planning of reconstructive procedures, facilitate patient recovery, and optimize functional and aesthetic outcomes. Speech pathology intervention aimed to 1) facilitate safe transition from nonoral to oral intake, 2) improve articulation and speech intelligibility, and 3) minimize oral contracture development. At 6 months postinjury, the patient can safely tolerate a soft diet, demonstrate speech clarity at preinjury level, and has recovered functional oral range of movement. Rehabilitation of speech and swallowing is an essential factor to consider when planning postburn reconstructive procedures.

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

“…Specific pharyngeal phase deficits that have been reported in literature to date for patients with burn injury include decreased BOT to PPW movement, reduced pharyngeal clearance and suboptimal hyolaryngeal movement 4,9,13 . Similar characteristics were observed across the cohort; a large proportion presented with reduced BOT to PPW contact and abnormal pharyngeal longitudinal and constrictor movement.…”

“…Burns to orofacial regions can result in oral phase difficulties, causing restrictions in range of motion (ROM) that impair lip and cheek movement, as well as jaw opening, thus limiting the proficiency of the oral phase of the swallow 4,5,[8][9][10][11][12] . In the presence of severe burns that result in orofacial scarring and contractures, oral deficits may be a longterm limiting factor in returning to normal oral intake 4,5 .…”

“…These deficits can manifest as poor ability to contain, manipulate and form a cohesive bolus of appropriate size and consistency for swallowing. Whilst the oral phase deficits have largely been discussed in single case reports that utilise clinical swallow examination (CSE) 5,6,8,9,12 , one study which detailed oral phase difficulties also observed during a modified barium swallow (MBS) study noted poor lip closure, decreased ability for mastication and decreased tongue to palate contact 4 .…”

Full thickness facial burns: Outcomes following orofacial rehabilitation

“…These include one cohort study [24], one small case series [7] and a number of single case reports [3][4][5][25][26][27]. The cohort study by Koller et al [24] examined vertical and horizontal mouth opening outcomes in patients following surgical debridement of burns to the face.…”

“…Full thickness injury of the orofacial region is well accepted in the literature to be a complex area to treat. Despite intervention, this region is prone to persistent b u r n s x x x ( 2 0 1 5 ) x x x -x x x scarring and contractures that manifest in many functional and aesthetic sequelae [1,2] such as poor oral opening and closure for the purposes of oral intake, oral/dental hygiene, intubation, as well as deficits in communicative ability characterised by impairments in articulation and facial expression [3][4][5][6][7][8].…”