A Psychosocial Review of 31 Patients with Severe Facial Burns

Abstract

The psychosocial problems of facial disfigurement following burns have been neglected in our society. We reviewed 31 burned patients with a set of questionnaire. All the patients belonged in Class 3 or Class 4 permanent facial impairment according to American Medical Association Criteria for Facial Impairment. The causes, functional and psycho social impairments were reviewed and analyzed. The main purposes are to draw public attention on the issue of severe facial disfigurement following bums and reemphasize the importance of coordinated and integrated medical, surgical, rehabilitative and follow-up care. 17 females and 14 males, ranging in age from 16 to 62 were included in our study. Inflicted bums were accounted for 55% of the causes of injuries, while 45% were accidental burns. Chemical burns was the most common injury in the former, while flame burn in the latter. The common functional sequalae, in order of frequency of incidence, were microstomia (65%), ear deformity (61%), cervical flexion contracture (58%), lower eyelids ectropirn (55%), and nostril stenosis (32%). Total blindness was noted in six patients sustained of inflicted chemical injuries. All patients received more than three operations in attempts to correct the functional and aesthetic impairment but only one of them was satisfied with the outcome. All patients sustained regressive syndrome for a period of 3 to 12 months after discharge. 55% of them developed suicidal idea and 19% attempted unsuccessful suicides. Only 19% of the patients have been attended by psychologists. Most patients had financial and employment problems. Family is the prime support for social recovery. Face is an important part of the body image. In a society that places a premium on physical beauty, and youth, the psychological and socioeconomic toll of facial disfigurement needs little explanation. A deep burn on the face will cause severe facial disfigurement and lead to disfigured face syndrome that expresses the situation in which the patient losses his value and role in life, feelings of emptiness and absurdity prevail. The main purposes of this paper are to draw public attention on the issue of severe facial disfigurement following burns and the importance of coordinated and integrated medical, surgical, rehabilitative and follow-up care.