Background & Aim: Burn injuries sustained from inhalation and ingestion are highly complex to treat. Mucosal wounds may be exacerbated by iatrogenic trauma in the context of life-preserving upper airway instrumentation with recent evidence citing potential long-term complications including incomplete voice recovery. Although it is recognised that wound healing in mucosa differs to cutaneous injuries with scar tissue formation often occurring late, treatment processes to mitigate scar contracture are lacking. We present a series of cases, featuring mucosal elements to their burn injury including novel treatment approaches applied, and their long-term outcomes.
Methods: Case series design. Four cases (4-male, aged 49-81 years) with burn injury (ranging 1-30% TBSA) including a confirmed inhalation component, were studied over a 12-month period. All cases required endotracheal intubation (range 2-5 days). Laryngeal range of movement exercises were applied prophylactically to mitigate scar contracture development and rehabilitation was loaded with respiratory-muscle-strength-training (RMST). Respiratory outcomes (Peak-Expiratory-Flow, Maximum-Inspiratory and Maximum-Expiratory-Pressure) and voice outcomes (maximum phonation time, GRBAS) outcomes were collected at baseline and throughout treatment.
Results: At baseline (post-extubation), clinical assessment revealed aphonia in all and profound dysphagia in 3 of 4 cases. Flexible nasendoscopic evaluation (FNE) revealed laryngeal slough, vocal process ulceration, poor vocal fold mobility and oedema in all cases. Laryngeal range of movement exercises loaded with RMST was well tolerated in 3 of 4 cases (1 case unable to engage in RMST due to severe dementia). Respiratory and voice outcomes improved in all cases with no residual deficit evident clinically or on FNE at 6-months post injury.
Conclusion: Outcomes from this case series suggest that early scar management approaches are feasible for laryngeal mucosal injuries and warrant further study. Given the frequently inaccessible nature for manual stretching techniques, a role exists for loading physiological structures with treatments such as RMST.