Management of extensive facial burns in the intensive care unit: introducing a novel device with a four-fold use.

Perioral facial burns have a high propensity to formation of microstomia and numerous prosthetic devices have been described that can be used postoperatively to address this problem. We introduce a novel device, the Whiston Buccal Prosthesis, which is used intraoperatively and in the early postoperative period and it acts as a surgical aid to prevent or curtail microstomia, as well as to address other problems associated with facial burns. Our device has an overall 4-fold purpose; 1) it acts as a commissural and circumoral retractor, 2) as a means of counter-pressure during excision of burn eschar, 3) counter-pressure for the graft after its placement, and 4) for access to the mouth to maintain oral hygiene. It has been used on 3 patients who have benefited from all or some of the above uses. We have used this device in 3 patients thus far. One died 2 months after her operation but received benefit in the daily maintenance of oral hygiene and also the skin grafts. The other 2 patients were young adults, 19 and 20 years old at the time of injury, who after a 3-year follow-up were discharged not having required any further surgical intervention for microstomia. The Whiston Buccal Prostheses were used for a length of time between 1 and 3 months. Although limited objective evidence exists for our device, subjectively we have seen value intraoperatively, in the prevention of microstomia, the maintenance of oral hygiene, and maintenance of grafts.