title: Management of extensive facial burns in the intensive care unit: introducing a novel device with a four-fold use.
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.
authors.affiliation: From the Whiston Hospital, Liverpool, United Kingdom.
authors.forename: Stratos S
authors.initials: SS
authors.lastname: Sofos
authors.forename: Hamid
authors.initials: H
authors.lastname: Tehrani
authors.forename: Elaine
authors.initials: E
authors.lastname: Goldsworthy
authors.forename: Jane
authors.initials: J
authors.lastname: McPhail
authors.forename: Kayvan
authors.initials: K
authors.lastname: Shokrollahi
authors.forename: Ian M
authors.initials: IM
authors.lastname: James
mesh_terms: D002056:Burns / Q000150:complications / Q000628:therapy*; D017266:Dental Prosthesis / Q000379:methods*; D005151:Facial Injuries / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008865:Microstomia / Q000209:etiology / Q000601:surgery; D009055:Mouth / Q000473:pathology / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult