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Orthognathic Surgery in Pediatric Burn Patients
Brian W. Starr, MD
Jillian M. Morrison, MD
David A. Billmire, MD
University of Cincinnati College of Medicine
2018-02-14
Presenter: Brian W. Starr, MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Ann Schwentker, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: The devastating impact of burn contractures on the developing pediatric skeleton has been well documented. However, there is a paucity of literature specifically related to pediatric head and neck burns and the surgical treatment of secondary craniofacial growth restriction.
Methods: An IRB-approved retrospective review was performed, examining records of head and neck burn patients treated with orthognathic surgery at Shriners Hospital, Cincinnati from 1997 to 2017. Demographics, type of injury, TBSA, type and number of operations, age at operation, indications and cephalometrics were recorded.
Results: Eight patients met inclusion criteria with an average age of 4.6 years at initial burn. The average TBSA and head and neck involvement was 22.6% and 7.3%, respectively. The mean age at orthognathic surgery was 16.3 years. The most common indications for orthognathic surgery were severe class II malocclusion and retrognathia. Four patients underwent combination bilateral split sagittal osteotomy (BSSO) with mandibular advancement and genioplasty; two patients underwent isolated BSSO advancement; one underwent combination Le Fort I osteotomy maxillary advancement, mandibular BSSO and genioplasty; and one underwent isolated genioplasty. The mean mandibular advancement was 10.6 mm. Each patient underwent an average of 5.1 secondary operations for constricting burn scars of the lower-mid face and neck.
Conclusion: Potential sequelae of burns to the head and neck in the pediatric population include retrognathia, micrognathia, class II malocclusion, and even obstructive sleep apnea. The multidisciplinary team must be aware of the long-term implications of these injuries and plan accordingly for orthognathic surgery and multiple secondary reconstructive operations.
