A classification system for postburn mentosternal contractures

Hypothesis: Postburn mentosternal contractures can be clinically classified into 4 major groups based on the location of the contracting band(s) and extent of flexion or extension away from the anatomical position of the neck and jaws. Each group can be further subclassified depending on the width of the contracting segment(s) and availability of surrounding supple skin. Design: Case series. Setting: Nigerian subregional apex hospital specializing in plastic surgery, orthopedic surgery, and traumatology. Patients: A consecutive sample of 41 patients with postburn mentosternal contractures who underwent surgery between 1997 and 2002 and 4 patients who had not yet had surgery, seen between January and March 2003. Data were obtained from operative records, photographic records, and interview of teams who treated the patients. During data collection, a classification system was devised in which mild, moderate, and severe anteriorly located contractures were designated types 1, 2, and 3, and posteriorly located contractures were considered type 4. Subtypes a through d were included to denote characteristics affecting reconstruction. Results: The classification system was successfully used to classify postburn mentosternal contractures as a guide to management. Sufficient data were available to classify 32 of the 45 patients. The observers were not blinded. Conclusion: The classification system is useful in describing severity and guiding reconstructive options, but further study is required before it is used in choice of airway management for anesthesia. ©2005 American Medical Association. All rights reserved.