Despite major advances in the area of
burn management,
burn injury continues to be a leading cause of pediatric mortality and morbidity. Facial
burns in particular are devastating to the affected child and result in numerous physical and psychosocial sequelae. Although many of the principles of adult
burn management can be applied to a pediatric patient with facial
burns, the surgeon must be cognizant of several important differences. Facial
burns and subsequent
scar formation can drastically affect the growth potential of a child's face. Structures such as the nose and teeth may become deformed due to abnormal external forces caused by
contractures. Serious complications such as occlusion
amblyopia and
microstomia must be anticipated and urgently addressed to avert permanent consequences, whereas other reconstructive procedures can be delayed until
scar maturation occurs. Furthermore, because young children are actively developing the concept of self, severe facial
burns can alter a child's sense of identity and place the child at high risk for future emotional and psychologic disturbances. Surgical reconstruction of
burn wounds should proceed only after thorough planning and may involve a variety of skin graft, flap, and
tissue expansion techniques. The most favorable outcome is achieved when facial resurfacing is performed with respect to the aesthetic units of the face. Children with facial
burns remain a considerable challenge to their caregivers, and these patients require
long-term care by a multidisciplinary team of physicians and therapists to optimize functional, cosmetic, and psychosocial outcomes.