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Facial burn contracture: eye and mouth

This case highlights the transformative impact of surgical intervention on a 4-year-old boy who had suffered from facial burn injuries two years prior. Deep burns to the face can result in disfiguring scars and contractures, impairing the function of essential anatomical structures such as the eyes and mouth. The patient received treatment at Haydom Lutheran Hospital in Tanzania, where a multidisciplinary team aimed to improve his condition and enhance his quality of life.

Medical history

At the age of 2, the boy experienced a severe burn while sleeping too close to a fire, resulting in burns to his face and hand. Initially, his father treated the wounds traditionally, but when they became infected, they sought medical care at Haydom Hospital. Despite a three-month stay for daily dressings, skin grafting was not performed. The family then sought care at KCMC Hospital in Moshi, where skin grafting was also not performed. The reasons for the omission of skin grafting in these hospitals remained unclear.

Upon learning about visiting plastic surgeons in Haydom, the family returned to the hospital in October 2015. During this second admission, the patient underwent treatment with split skin grafts and full-thickness grafts around the eye (Photos 1a & 1b). However, contractures had already developed, affecting the left eye and mouth, leading to impaired vision in the left eye.

Physical examination

The patient exhibited contractures of the right upper and lower eyelids, with scarring extending to the cheek and forehead. He was unable to close his left eye or mouth properly. Severe scarring of the left cornea resulted in redness, swelling of the sclera and mucosa, and limited vision.

Surgery

The surgical team marked the incision sites and utilized Jungle Juice for hemostasis. Incisions were made above and below the left eye and on the left side of the mouth, carefully dissecting the scar tissue to assess the extent of the contracture. To close the eye, the eyelids were sutured together. Skin defects were covered with full-thickness grafts from the abdomen, secured in place with tie-over sutures, and Vaseline gauzes with tetracycline.

Postoperative care

The tie-over sutures and Vaseline gauzes were left in place for five days. After removal, gentle non-contact rinsing of the eye was recommended to facilitate healing.

Outcome

The grafts healed well, and at the six-month follow-up, both the patient and his father expressed satisfaction with the results. Although the appearance of the face remained different from normal, the patient regained the ability to close both eyes and his mouth, and he experienced relief from pain (Photos 8 & 9). However, during the most recent follow-up in August 2021, it was observed that the lower eyelid had retracted, necessitating further surgery scheduled for the following training camp at Haydom Lutheran Hospital 9 (Photo 10).

Lessons learned

The initial procedure in 2015 focused on wound closure, with subsequent operations planned. A staged approach to reconstructive surgery, particularly in contracture release, was deemed necessary, with an approximate six-month interval between procedures. Unfortunately, due to a loss in follow-up, the patient was not seen again until 2021. Reflecting on their experience, the patient and his father advised others to seek immediate medical care after burn injuries and to avoid relying solely on traditional medicine. They also expressed hope that the hospital would be able to offer skin grafting services in the future.

This case underscores the importance of timely and comprehensive treatment for burn injuries, emphasizing the need for multidisciplinary care and access to specialized surgical interventions.

Case

Facial burn contracture: eye and mouth