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Facial, oral, and airway thermal injuries and anaesthesia 

Facial, oral, and airway thermal injuries and anaesthesia
Chapter:
Facial, oral, and airway thermal injuries and anaesthesia
Author(s):

Tim Vorster

DOI:
10.1093/med/9780199564217.003.0015
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date: 17 February 2020

The remit in this chapter, and rationale for inclusion in this book, is to discuss facial and oral burns management for anaesthetists. The pure surgical aims of treating facial and oral burns are identical to the treatment of burns elsewhere on the body, that is to excise non-viable burned tissue, allow viable tissue that has the capacity to heal quickly, to heal in a time-frame that will make scaring minimal, and to cover debrided areas with skin grafts or skin substitutes in order to maximize cosmetic and functional result.

However, facial and oral burns are seldom an isolated injury, and are often a harbinger of more immediate life-threatening insults to the patient as a whole. Acute thermal airway burns are seldom encountered without an associated facial burn, and require the immediate attention of a skilled anaesthetist. Other aspects of the ‘smoke inhalation complex’ will also be commonly involved and require assessment and appropriate treatment prior to any evacuation to a Burn Unit. Though not all patients with facial burns will have an associated inhalation burn, the vast majority of inhalation injury patients do have a facial burn. The presence itself, of a full thickness facial burn, has been shown to be an independent indicator of a significant increase in the probability of death, when compared with similar size burns elsewhere (logistical regression coefficient 0.70). It is proposed that this is due to the close association between this type of burn and the presence of an inhalation injury. Those who suffer facial and oral burns are very fortunate, if it can be said under such circumstances, to escape with these as their only cutaneous thermal injury. Facial burns are often just a small part of the overall burn seen in patients with massive thermal injuries. Also, it must be noted, a significant number of burn victims will have other injuries and coexisting pathologies that will need evaluating, and appropriate management.

This chapter is designed to give a brief outline of burns treatment, with a specific emphasis on inhalation injury and the airway management in these cases. Within the limits of the chapter, a somewhat holistic approach to the subject of burns injuries in general, rather than just injuries in an isolated anatomical area is warranted.

It will briefly touch on burns resuscitation, but the reader is advised to consult other textbooks specifically dealing with all aspects of burns treatment for a more thorough overview. An alternative is to enrol in the Emergency Management of Severe Burns (EMBS) course run in the United Kingdom (UK) via The British Burn Association3.

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