Rehabilitation of speech and swallowing after burns reconstructive surgery of the lips and nose

J Burn Care Res. 2009 Nov-Dec;30(6):1039-45

Clayton NA, Ledgard JP, Haertsch PA, Kennedy PJ, Maitz PK.
Speech Pathology Department and Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.


Rehabilitation of speech and swallowing postburns reconstructive surgery has not been previously described in detail in the literature. Severe facial burn injury requiring subsequent reconstructive surgery may result in complications including circumoral contracture and aesthetic and functional irregularities. These complications may manifest as facial and labial sensation deficits, poor oral access for intubation and oral/dental hygiene, and inadequate oral competence causing chronic drooling and poor articulation. This report describes the physical rehabilitation of a patient with full-thickness burns to the nose, lips, mouth, and chin following electrical burn injury. The severity of injury sustained placed the patient at high risk for microstomia, dysphagia, and speech disorder. A multidisciplinary team approach was used to coordinate the planning of reconstructive procedures, facilitate patient recovery, and optimize functional and aesthetic outcomes. Speech pathology intervention aimed to 1) facilitate safe transition from nonoral to oral intake, 2) improve articulation and speech intelligibility, and 3) minimize oral contracture development. At 6 months postinjury, the patient can safely tolerate a soft diet, demonstrate speech clarity at preinjury level, and has recovered functional oral range of movement. Rehabilitation of speech and swallowing is an essential factor to consider when planning postburn reconstructive procedures.