2017-18 HSC Section 3 Green Book

b u r n s 4 3 ( 2 0 1 7 ) e 7 – e 1 7

[(Fig._1)TD$FIG]

0 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 FOIS score DuraƟon of RehabilitaƟon (weeks) FOIS outcomes

Case 1

Case 2

Fig. 1 – Clinical swallowing outcome data (FOIS). FOIS scale: 1, nothing by mouth; 2, tube dependent with minimal attempts of food and fluid; 3, tube dependent with consistent intake of food and fluid; 4, total oral diet of a single consistency; 5, total oral diet with multiple consistencies but requiring special preparation or compensations; 6, total oral with multiple consistencies without special preparation, but with specific food limitations; 7, total oral diet with no restriction.

3.3.

Case 2: Medical history

treatment at Day 433 post injury (329 days of intervention). No functional limitations were evident as a result of mouth opening at the time of treatment cessation, with linear measurements recorded at 39 mm for VROM and 64 mm for HROM. At the time of orofacial treatment completion, a score of 2 on the VSS was obtained with a slight reduction in the pliability measure (1) and evidence of hypopigmentation (1). Additionally, Case 1 obtained a cumulative score of 25/120 on the POSAS (Patient Scale 13/60; Observer Scale 12/60) falling at the lower end of this scar scale towards normal tissue, where normal tissue is represented by a cumulative score of 12.

Case 2 was an 18 year old [11_TD$DIFF] man with 76% TBSA flame burns to face, neck, chest, back, upper and lower limbs with concomi- tant inhalation injury. He underwent a period of intubation for 20 days from the time of admission before [12_TD$DIFF] receiving insertion of tracheostomy due to inability to wean ventilation. Once ventilation was able to be successfully weaned, the patient progressed through the tracheostomy weaning pathway and was successfully decannulated on Day 40. Case 2 also underwent multiple surgical procedures including

Table 3 – Fibreoptic endoscopic evaluation of swallowing outcome data. Case 1

Case 2

Baseline 1 month 2 month 3 month 4 month Baseline 1 month 2 month

Oedema a

Moderate Mild

Normal

Normal Normal

Normal Normal

Mild

Mild

Normal Normal

Secretions b

Severe

Mild

Moderate

Profound Mild

Penetration aspiration c Thin

7 7

5 –

2 1

2 –

1 –

– –

2 1

1 –

Mildly thick

Vallecular residue d Thin

Moderate Moderate

Mild

Trace

None

– – – – – – – –

Mild Mild

None

Mildly thick

Severe

– – –

Moderate Moderate Moderate

–

– –

– –

Minced and moist

– –

Trace

Moderate

Soft

Mild

None

–

None

Piriform residue d Thin

Severe Severe

Severe

Mild

Mild

None

Mild Mild Mild

None

Mildly thick

– – –

Moderate

–

– –

– –

Minced and moist

– –

Mild Mild

Mild Mild

Soft

Trace

–

None

a Oedema scale: 1, normal; 2, mild; 3, moderate; 4, severe (Patterson et al. [40] ). b Secretion scale: 1, normal; 2, mild; 3, moderate; 4, severe; 5, profound (Donzelli et al. [39] ).

c Penetration aspiration scale: 1, material does not enter airway; 2, material enters airway above vocal cords and is ejected; 3, material enters airway above vocal cords and is not ejected; 4, material enters airway, contacts vocal cords and is ejected; 5, material enters airway, contacts vocal cords and is not ejected; 6, material enters airway, passes below vocal cords and is ejected; 7, material enters airway, passes below vocal and is not ejected despite effort; 8, material enters airway, passes below vocal cords with no effort made to eject (Rosenbek et al. [37] ). d Vallecular and piriform residue scale: 1, none; 2, trace; 3, mild; 4, moderate; 5, severe (Neubauer et al. [38] ).

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