Anterior neck contractures have been classified based upon the location of the band and the degree of flexion and extension away from the anatomical position of the neck and jaw.²

The width of the contracting segments and availability of supple surrounding skin is also considered in the classification of the deformity.²

The key anatomical considerations are the burn scar crossing the mobile cervical-mental angle or the manubrium.

Burn scarring above the cervical-mental angle will primarily affect the chin, lower lip, and mandible.

When the burn crosses the angle, the mandible and head are pulled into flexion.

Neck burn scar contractures in the pediatric patient can be severe secondary to the propensity to hypertrophic scarring, which may develop rapidly in the initial weeks following the injury.

Significant neck burn scarring creates a persistent downward force on the lower lip, chin, and eyelids resulting in ectropion and AP growth restriction of the mandible.³

Contractures may be severely disfiguring and functionally impair neck motion, making eating and communication problematic.

The airway may become compromised and intubation difficult.

In extreme cases, scarring pulls the chin down to the chest wall, elongating the mandible and severely affecting the airway.

The natural history and progression is dependent on the depth of the burn wound, the inherent tendency toward scarring, the age of the child, and the initial treatment and management.

Neck burn scar can exert considerable pressure on the growing mandible and adversely affect growth.

Depending on the vector of pull, the AP growth of the mandible can be negatively affected and require later genioplasty or even a BSSO with advancement.¹

In the most severe cases where the mandible is drawn down to the chest, mandibular lengthening and eventual setback may be required.

A detailed assessment of the patient’s functional limitations is documented.

Previous treatment of the neck burn injury should be noted as well as compliance with stretching and splinting.

Note the specific anatomic location of the neck burn contracture, width of scar bands, and whether supple nonburned soft tissue is present.

Deformities such as lower lip and eyelid ectropion affected by the neck contracture should be noted.

Occlusion is assessed—loss of chin projection and class II occlusion may develop over time.

Range of motion and ability to extend the head and neck should be measured.

The patient should be assessed for potential intubation difficulty.

Availability of potential donor sites for surgical planning should be assessed.

Imaging is rarely required unless growth disturbances are suspected.

A standard lateral cephalogram is useful to follow the patient.

In the scar maturation phase of the burn wound, splinting and stretching are recommended to reduce the contracture.

Depending on the severity and extent, contracture releases may be accomplished by a variety of techniques including split-thickness or full-thickness skin grafting, local flaps, tissue expansion, and local flaps or a free flap.