Alternative use of the electrical burn appliance.

Electrical burns to the oral commissure result in significant contracture, with resultant microstomia and severe disfigurement if left untreated. Successful management requires the skills of both the pediatric dentist and plastic surgeon, and good cooperation from the patient and parents. Splinting appliances reportedly have reduced the possibility of scar contracture following a burn to the lips and/or commissure. The splinting appliances (fixed or removable) are worn continuously, usually for six to 12 months until the scar tissue has lost its contractile property." The splinting appliance is easy to fabricate, and its design allows it to be utilized for procedures other than electrical burn treatment. Recently, the appliance was adapted to assist in facial reanimation surgery for facial paralysis. Patients with facial paralysis secondary to congenital defects, malignancies, and viral illness desire the restoration of normal involuntary function on the affected side. The surgical procedure, although not perfected at this time, offers some hope to patients who suffer from facial paralysis. The surgery is completed in two steps. Initially, branches of the facial nerve from the unaffected side are tunneled across the face to the opposite side (cross facial nerve grafting). This is followed by transplantation of a portion of the gracilis muscle, complete with artery, vein, and nerve, to the affected side between the zygoma and the commissure. The nerve is anastomosed carefully with the previously crossed facial nerve, and the vein and artery are anastomosed with the facial nerve and artery. The cross facial nerve grafting must be completed six to 12 months before the muscle transplant to allow for neurotization of the nerve. It is necessary to graft the gracilis muscle, because longterm facial paralysis results in significant muscle atrophy on the affected side.' The key to the success of this surgery is good nerve, artery, and vein anastomosis, proper muscle size selection, and applying the appropriate muscle tension to give a natural result to the patient. The splint is used during the immediate postsurgical period to assure that the appropriate amount of muscle tension is applied; this may prevent muscle detachment by keeping the commissure from being pulled toward the midline by muscle activity of the normal side.