Reabilitação motora orofacial em queimaduras em cabeça e pescoço: uma revisão sistemática de literatura

Managing Long-term Orofacial Contractures and Microstomia Through Intraoral Stretching

Microstomia and orofacial contractures continue to garner interest regarding the effectiveness of treatment methodologies utilized to impact functional change. Oral splints are an accepted tool in the management of microstomia. However, the concepts of which oral splints to use, timing of initiation, and duration of treatment have not gained a consensus. This article reviews approaches to oral splinting and an alternative intraoral approach using splints designed to provide a graded, low load, multidirectional, and prolonged stretch specifically in facial burn survivors including those with mature scars. Two participants participated in a trial using oral splints placed inside the mouth at established contracture points. Participants were requested to use the splints for 1 h twice daily. Participants were photographed weekly producing 9 facial expressions, and distance between 13 facial landmarks was measured to evaluate change in tissue length. Numerical changes observed from beginning to end of the trial indicate positive and negative alterations, signifying lengthening or shortening of tissue. Negative changes denote reduction in distance between endpoints, while positive changes signify an increase. Participants verbalized functional improvements in oral motor and psychosocial function posttreatment. To date, oral splints can be custom fabricated for each individual patient. However, few oral splints are created to provide multidirectional stretch focusing on problem areas across the mid and lower face. The intraoral splints and regimen described here have the capability of providing a stretching intervention that could be applicable in various stages of burn recovery.

Optimising Scar Management Intervention in the Case of a Head-and-Neck Burn for a Patient with a Learning Disability

Scars following burns can often prove complex to manage, particularly when crossing joints or special areas such as the head and neck, due to contractures. This case report discusses the individualised care and rehabilitation provided to a burn patient with a learning disability. The patient suffered both full and partial thickness burns equating to a total body surface area (%TBSA) of 7% of the face, neck, and anterior chest via the self-ignition of clothing. Acute treatment was provided at a regional burn unit followed by further in-patient care and rehabilitation at our burn facility. A motion rehabilitation instrument was employed to manage potential orofacial contracture; however, due to the patient's impaired social functioning, this device was found to be unsuitable. Subsequently, a bespoke mouth-opening device replicating an ice lolly was fabricated utilising computer-aided design (CAD), enhancing the patient's understanding along with encouraging independence. Microstomia was a risk in this case; however, this was prevented via the discussed regime, and successful patient rehabilitation was achieved.

Rehabilitation of Burn Victims: Improving Quality of Life in Victims With Face and Neck Burn Through an Augmented Reality Coupled Pamphlet

The present study aimed to investigate the effect of implementing rehabilitation programs using an augmented reality (AR) coupled pamphlet on the quality of life (QOL) of patients with face/neck burns. This randomized clinical trial was conducted on 60 patients (intervention = 30, control = 30) admitted to the burn center of Imam Reza Hospital, Mashhad, Iran. Patients in the intervention group performed their rehabilitation program using AR coupled pamphlet during 6 weeks, while control patients used simple pamphlet. The Burn-Specific Health Scale for Face and Neck (BSHS-FN) was completed at the beginning, and 2 and 6 weeks after the intervention. The results for 2 weeks after intervention measures in model 1 ANCOVA showed significant raise of measures only for Hand function (P = .035). However, for the total QOL score and other domains the differences were not significant (All P > .05). Adjusting for confounders, model 2 ANCOVA showed similar results for 2 weeks after intervention. However, in both models, the results indicated significant intervention effect for 6 weeks after intervention in QOL score and all domains (All P < .05), so that the amount of increase in measures were significantly higher in the intervention group. According to the findings, implementing rehabilitation program for patients with face and neck burns using AR coupled pamphlet can improve their QOL.

Orofacial rehabilitation after severe orofacial and neck burn: Experience in a Brazilian burn reference centre

OBJECTIVE

To quantify the benefits of a functional oral rehabilitation program for impairment caused by full thickness orofacial and neck burns, comparing the effects of early and late intervention.

METHODS

An observational cross-sectional study was conducted in a burn reference center over a two-year period. Patients with full thickness orofacial and neck burns were divided in two groups: Group 1 was composed by 14 patients who began the rehabilitation program 3-12 months after the burn injury; Group 2 was composed by 15 patients who began the rehabilitation program more than 12 months after the burn injury. Treatment was based on current strategies of non-surgical exercises for orofacial contracture management. Outcome measurements included an oral motor clinical evaluation and the assessment of the mandibular range of movement.

RESULTS

The functional rehabilitation program was effective in reestablishing the oral motor functions (i.e deficits reduced to approximately 15% when compared to the optimal possible scores) and in restoring horizontal mouth opening dimensions, with more than 70% of the patients presenting measurements within the expected normal limits at the end of treatment. Our results did not indicate differences in performance between the group of patients in neither set of assessments, i.e. pre and post treatment (p > 0.05).

CONCLUSION

The results of this study indicate that non-invasive orofacial contracture management is effective for patients with orofacial and neck burns, including those with long term sequelae.