Integrated surgical approaches for caustic ingestion-induced microstomia

Area of Science:

• Reconstructive surgery
• Pediatric surgery
• Otolaryngology

Background:

• Caustic ingestion causes microstomia, severely impacting function and quality of life, especially in children.
• Current management strategies for microstomia are inconsistent and lack standardization.

Purpose of the Study:

• To evaluate a standardized institutional protocol for managing caustic ingestion-induced microstomia.
• To assess the functional outcomes and efficacy of a multimodal treatment approach.

Main Methods:

• A PRISMA-compliant systematic literature review was performed.
• A series of 11 patients treated with a standardized protocol involving scar release, mucosal flaps, split-thickness skin grafting (STSG), and custom appliances were analyzed.
• Key outcome measures included intercommissural distance (ICD) and interincisal distance (IID) changes.

Main Results:

• Literature review identified 13 studies with 19 patients, noting heterogeneous techniques and inconsistent appliance use.
• The institutional protocol resulted in significant increases in mean ICD (17.3 mm to 34.0 mm) and IID (11.0 mm to 22.8 mm).
• Complications were generally minor and related to dental issues, appliance irritation, or the initial injury.

Conclusions:

• A multimodal strategy using STSG, tissue expansion, standardized postoperative appliances, and multidisciplinary follow-up achieves lasting functional improvements.
• While complex, the protocol's principles are transferable and can guide other centers in managing microstomia.