PubMed · 4851833
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D B Swerdlow, E P Salvati, R J Rubin, S B Labow. Electrosurgery: Principles and use.. https://doi.org/10.1007/bf02587025
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A male infant aged one year and nine months was found dead on a bed after admission to hospital with suspected pneumonia. The patient apparently put an uncovered oval shaped lamp switch (pendant switch) into his mouth and died of electric shock after contacting the exposed wires of the switch (100 V, 60 Hz alternating current). There were extensive first- to fourth-degree burns on the inner surface of the both lips. Because the histological findings were consistent with electric burns and the burns showed vital reactions, electric shock was judged to be the cause of death. The pendant switch is normally a very convenient piece of bedside equipment for inpatients. However, when the patient is an infant who naturally puts all the objects into the mouth, such a switch should be placed out of reach, and it should be certain that the cap is not loose.
Two groups of children who had sustained electrical burns to the oral commissure were compared. The first group (n = 20) underwent splinting of the commissure and the other group (n = 22) did not have splints as part of their treatment regimen. The mean age at the time of burn was 3 years in both groups. The need for commissuroplasty was significantly decreased in the splinted group (P = 0.0007 by Fisher's exact test). Further analysis of the duration of splinting in the splinted group (n = 20) revealed that all seven children who required commissuroplasty underwent splinting for less than 4 months while all 13 children who did not require surgery used their splints for more than 4 months (range 4-8 months).
Electrical burns of the mouth are relatively common in young children. Early intervention to prevent complications remains controversial. A chart review was conducted of 24 patients with oral commissure burns who were treated at the University of Iowa from 1975 to 1988. All of these patients were treated conservatively without splinting or early surgery. Only one patient underwent oral splinting before receiving care at the University of Iowa Hospitals and Clinics. While under our care, no patients suffered significant hemorrhage at eschar separation. Commissuroplasty and/or reconstructive lip surgery were performed at various times after the burn injury was healed and the functional or aesthetic impairment was established. Long-term follow-up was from 5 to 17 years, allowing for longitudinal evaluation of the postburn scars and their influence on facial growth. Our review revealed that (1) younger children with more severe burns have a less favorable outcome; (2) no hemorrhage was observed immediately after the burn or at eschar separation; and (3) conservative surgical treatment after scar maturation- and in some cases following steroid injections- resulted in a successful functional and esthetic outcome.