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Though responsible for just 4% of burn centre admissions, electrical injuries present in a myriad of ways. From small, innocuous, partial-thickness injuries on the fingertip, to a high-voltage injury requiring amputation and complex reconstruction, the burn surgeon must be equipped with the knowledge and skill to deal with such varying injuries. This chapter describes the epidemiology of electrical injury and the pathophysiology of electrical current passing through the patient. The management of high- and low-voltage wounds is described, as is the treatment of the systemic effects of the electrical injury.

This chapter explores velopharyngeal dysfunction (VPD), its impact, aetiology, assessment, and management. VPD may cause hypernasal, weak, and unintelligible speech, facial grimacing, nasal turbulence and nasal regurgitation, middle ear problems, and sinusitis. Such manifestations may be distressing for the patient, be associated with poor academic outcomes, be negatively perceived by others, lead to bullying and withdrawal, and result in relationship and employment difficulties. Like the effect of a visible difference on psychosocial confidence and self-esteem, the manifestations of VPD on emotional well-being and social interaction do not necessarily correlate with the amount of speech, language, or communication dysfunction. Normal anatomy, neuromotor function, and speech learning are prerequisites for effective velopharyngeal function. A problem with any of these components may result in a velopharyngeal mechanism that fails to efficiently and fully close throughout oral speech sound formation leading to VPD and an ensuing speech disorder. Perceptual speech evaluation is used to diagnose VPD. Lateral videofluoroscopy and nasoendoscopy are commonly deployed to assess velopharyngeal function and determine management strategies. Surgical interventions include pharyngoplasty, pharyngeal flaps, and velopharyngeal augmentation. Non-surgical interventions include speech prostheses and nasal obturators for speech improvement.

Numerous classifications, including LAHSAL and Kernahan’s striped Y, aid organizing the heterogeneous nature of typical orofacial clefts. Antenatal diagnosis occurs in approximately 80% of births and is more accurate for diagnosing cleft lip than cleft palate. Most parents find antenatal diagnosis beneficial for psychological adjustment and planning prior to the birth. Airway assessment is vital in neonates with a cleft. Most, even those with severe Robin sequence, can be managed non-surgically with lateral or prone positioning, a nasopharyngeal airway, and supplemental oxygen. Sleep studies are an important means of assessing the airway. Feeding is a major concern in babies with a cleft; early feeding intervention and parental education is important. Other conditions, including Robin sequence, 22q11 deletion syndrome, Stickler syndrome, and van der Woude syndrome, must be identified early in conjunction with the cleft multidisciplinary team. Genetic analysis and counselling should be considered.

Lips, the dynamic centre of the lower third of the face, are vital functionally and socially. They provide oral competence, the loss of which can lead to drooling and difficulty eating. Socially, lips facilitate articulation, facial expression, and intimate human interaction. They are a defining feature of beauty in many cultures. Malignancy, trauma, and congenital anomalies may generate perioral defects requiring reconstructive strategies which have gradually evolved.