Infant commissural burn management with reverse pull headgear.

The care of a commissural ip burn of an infant can be a challenge. The prevalence, pathophysiology, surgical management, various positive pressure treatment modalities, and concepts important to prevention are discussed in this case report. The management of the commissural burn of a ninemonth-old infant with a dental appliance which was anchored with a reverse pull headgear is described. Upon reaching the age of approximately six months, the infant begins to crawl and eagerly explore the environment to the extent of parental and physical limitations. Using all sensory organs, especially taste, nearly every new discovery is placed into the mouth; the infant is therefore dangerously prone to ingesting poison, aspirating small objects, and burning the commissures of the lips by placing the live end of an electrical cord into the mouth. The following report describes the use of a reverse pull headgear in the management of an oral commissural burn sustained by a nine-month-old infant. Prevalence of Oral Burns Among Children The prevalence of oral electrical burns among infants has not been comprehensively studied. Thompson et al. (1965) reported that between 1945 and 1963, 45 children with electrical burns to the mouth were admitted for treatment to Children’s Hospital in Toronto. Six children were younger than one year of age. Sixty-five per cent of the burns were to children between the ages of one and two years and 28% affected children between two and four years. Oral electrical burns to children represented 1.7% of all burn admissions. One of the 45 electrical burns resulted in death. Orgel et al. (1975) reported that between 1957 and 1972, 51 children were seen at Montreal Children’s Hospital for electrical burns to the mouth. There was a greater predominance of males and 29 of the 51 children were between one and two years. Similar data were presented in which the majority of cases involved children younger than four years with an equal prevalence of males and females. 1 Davies et al. (1958) reported oral burn cases among 1893 admissions to the burn unit at another hospital during a five-year period for an incidence of 3.7%. Over a seven-month period at the University of Texas Health Science Center at San Antonio, 25 children were admitted to the hospital with burns to various parts of the body, and eight cases involved lip burns which represented 10.8% of total burn admissions. The majority of these injuries were associated with the electrical connection of household appliances by an extension cord (Richardson and Kittle 1981). Pathophysiology of Burns Tissues with the highest water content are the least resistant to electrical current and, consequently, suffer the most damage from electrical insult. Blood, muscle, skin, tendon, fat, and bone are affected in decreasing order of resistance. Tissue damage caused by electricity may appear minor at the entrance and exit points, but the underlying tissue damage is more severe. Electrical burns can cause internal hemorrhage, intestinal perforation, shock, and cardiac arrest at the time of the injury. The seriousness of a burn is dependent upon the depth of penetration. Partial thickness burns are characterized by tissue destruction in varying depths between the epidermis and the dermis. Full thickness burns include the epidermis, the dermis, and damage to the subcutaneous layers including muscle and bone (Hills and Birmingham 1981). Electrical burns are commonly classified as being either contact or arc burns. The contact lesion has entry and exit sites and the current usually passes from the point of contact to the ground. l Fogh-Anderson and Sorensen 1966; Gifford et al. 1971; Gormley et