A Novel Adjunct for Treatment of Orofacial Contractures After a Facial Burn Injury

Abstract

Purpose: Surgical management of scar tissue and contractures from facial burns has systematic approaches, yet nonsurgical management continues to lack consensus regarding therapeutic approaches capable of providing stretching of the facial skin and muscles for both treating and preventing microstomia and orofacial contractures. This exploratory study introduces an intraoral splinting system designed to provide low-load, prolonged stretching of orofacial skin and musculature to treat contractures following a facial burn injury. The treatment adjunct described here has potential application across disciplines treating microstomia and orofacial contractures. Method: An 18-year-old man with full-thickness head and neck burns participated in a 5-week trial using intraoral splints to provide stretch to areas of contracture in the mid and lower face. The trial commenced 4 and a half months after his burn injury. Prescriptive placement, sizing, and time for use of the splints were provided. Changes in distance between facial landmarks were identified for 13 measurements taken for nine facial expressions. Results: Lengthening or shortening of the distances between two landmarks indicated the potential benefit from intraoral splints. For the expression “open mouth wide,” increased distance between two end points was noted in 11 of 13 measurements, ranging from 1.6 to 10.8 mm. This represents a lengthening of tissue, allowing for wider oral opening. Negative measurements between two end points occurred in two of 13 measurements, demonstrating elevation of the left and right nostrils. Visual data also demonstrated the appearance of change. Conclusions: When treating microstomia and orofacial contractures, consideration should be given to the use and further exploration of a more targeted intraoral methodology that uses a low-load, prolonged stretch to improve functional and aesthetic deficits. Oral splinting using an intraoral methodology is underutilized in the burn patient population and has application in both the acute care and chronic phases of recovery.