Electrical burns of the mouth in children.

The acceptable state of the art for commissure electric burns of the mouth in children in the past was to advocate conservative treatment, allowing spontaneous healing to be followed by reconstructive procedures. These statements were made because of the difficulty of assessing the degree of initial injury, the loss of valuable normal tissue in early excision and reconstruction, and the minor role played by infection in healing of local electric burns particularly in this anatomic area. Most authors feel that maximum tissue preservation and functional restoration could best be achieved by delay of surgery until the eschar had separated and the scar had softened. Another school of surgeons believe that scarring, distortion, and secondary infection can be circumvented by timely, early surgical intervention. More recently the fabrication and use of a "dynamic microstomia prevention splint" appears to be beneficial in eliminating the need for or decreasing the degree of surgery in children with electric burns of the commissure of the mouth.

Compensatory reconstruction of the lips and mouth after major tissue loss.

When any procedure is probably going to alter form and function, the surgeon must be aware of the various trades and select the reconstruction that provides the greatest net gain. It is almost trite to reemphasize the need to listen to and heed as best as possible the needs and desires of the patient. Only by having a knowledge of the effects on normal function and previsioning the resultant deformity can we adequately compensate for major lip and mouth tissue loss. We have attempted to look into the corners of this profusely authored subject to more clearly understand the compensatory nature of its reconstruction.