Modern Plastic Surgery, 2013, 3, 68-70
http://dx.doi.org/10.4236/mps.2013.32013 Published Online April 2013 (http://www.scirp.org/journal/mps)
A Rare Complication: Perioral Burn Related to
Electrocautery Use during Adenotonsillectomy
Erkun Tuncer1, Sadık Şentürk2
1Department of Otolaryngology—Head and Neck Surgery, Mevlana (Rumi) University Hospital, Konya, Turkey; 2Department of
Plastic and Reconstructive Surgery, Mevlana (Rumi) University Hospital, Konya, Turkey.
Received February 22nd, 2013; revised March 25th, 2013; accepted April 1st, 2013
Copyright © 2013 Erkun Tuncer, Sadık Şentürk. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Electrocautery is frequently used for incisions and bleeding control during adenotonsillectomy which is one of the most
commonly performed pediatric surgical procedures. Although cases of perioral burn related to electrocautery use are
rarely reported complications in literature, they account for a significant portion of malpractice lawsuits. The use of
insulated surgical tools and lip protective equipment, careful surgery, and the frequent control of surgical equipment
may decrease the number of this complication. This study examines whether a rarely reported complication related to
perioral burn is indeed rarely seen or whether there are problems in reporting the real rates because it is evaluated to be
a case of malpractice, and the protective factors that will prevent this problem. Consequently, it is underlined that this
complication, which is more frequently seen than it is reported, should be a part of preoperative information process and
the consent form.
Keywords: Burn; Adenotonsillectomy; Tonsillectomy; Malpractice; Perioral Burn
1. Introduction
The most frequently reported complications related to
adenotonsillectomy, which is one of the most commonly
performed pediatric surgical procedures, include bleed-
ing, pain, dehydration, fever, airway obstruction related
to edema, nasopharyngeal stenosis, voice change, and
velopharyngeal insufficiency [1,2-4]. The rate of perioral
burns after adenotonsillectomy is between 0.01% and
0.04% according to literature [5-7]. Although cases of
perioral burn related to electrocautery use are rarely re-
ported complications in literature, they account for a sig-
nificant portion of malpractice lawsuits [1]. The use of
insulated surgical tools and lip protective equipment,
careful surgery, and the frequent control of surgical
equipment may decrease the number of this complication
[7,8]. Although perioral burn cases have been rarely re-
ported, different stages of this complication is frequently
seen and therefore we believe that perioral burn as a
complication should be included in the preoperative in-
formation process and in the content of the consent form.
2. Case Report
A 10-year-old male patient presented with a complaint of
deep injury on his lip. The patient’s physical examination
demonstrated that he had a third-degree burn of about 2
cm in size covering the skin, mucosa, and the orbicular
muscle on his lower lip’s right comissure and he was
hospitalized for treatment (Figure 1). The patient’s me-
dical history revealed that he had had an adenotonsillec-
tomy procedure performed under general anesthesia be-
cause of chronic adenotonsillitis at another medical cen-
ter 3 weeks before his presentation at our clinic. His rou-
tine pre-op lab results were normal. The necrotic tissue
on the lower lip was debrided under general anesthesia
and the oral mucosa was repaired with 5-0 absorbable
suture. Following the repair of the orbicularis oris muscle,
which was dissected on both sides of the defect, with 4-0
absorbable suture, the skin was primarily closed with 6-0
polypropylene suture. The patient’s post-op course was
without any problems and the result was satisfactory
(Figure 2).
3. Discussion
Perioral burn is a rarely reported complication (0.01% -
0.04%) when its incidence rate is compared to complica-
tions like bleeding, pain, dehydration, fever, airway ob-
struction related to edema, nasopharyngeal stenosis, voice

A Rare Complication: Perioral Burn Related to Electrocautery Use during Adenotonsillectomy 69
Figure 1. Preoperative view.
Figure 2. Postoperative view.
change, and velopharyngeal insufficiency which are fre-
quently reported related to the adenotonsillectomy pro-
cedure [5-7]. Although cases of perioral burn related to
electrocautery use are rarely reported complications in
literature, they account for a significant portion of mal-
practice lawsuits [1,7].
While 81% of perioral burns that develop during ade-
notonsillectomy procedures are first-degree, 12% of them
are third-degree burns [7]. First-degree and second-de-
gree burns can frequently be healed by antibiotic oint-
ments without having to perform surgical procedures.
Third-degree perioral burns, however, might necessitate
advanced reconstructive surgical procedures depending
on the size of the defect. Though rarely seen, when burns
include the oral comissure they might cause aesthetic and
functional losses like microstomia. The period following
the separation of the eschar tissue from the surrounding
healthy tissues is the most viable period for the surgical
reconstruction of third-degree burn cases [9].
Electrocautery is frequently used for incisions and
hemostasis in oropharyngeal surgery. Perioral burns are
most commonly caused by monopolar cautery use which
is followed by the coblation technique. Bipolar and aspi-
ration cautery result in relatively less injury. The defects
of the tip of the electrocautery device are most com-
monly identified as the cause of perioral burns [7,8].
Other than these causes, oropharyngeal burns were de-
fined as resulting from the inflammation of the flamma-
ble anesthetic gases which infiltrate into the surgical site
related to the use of intubation tubes without balloons [6,
10].
The use of endotracheal tubes with balloons may de-
crease the risk of complications related to inflammation
by reducing the amount of oxygen-rich gas leaks into the
surgical site [10]. Aspiration that continues during the
whole procedure may prevent inflammation by blocking
the accumulation of flammable gas in the surgical site.
Surgical techniques have been defined in order to prevent
burns caused by leaks in the electrocautery device [8,11].
In addition to these techniques, a careful check of the
insulation errors of the surgical equipment during the
procedure will bring about adequate protection. Further,
the use of protective barriers and lip protecting equip-
ment that increases vision and decreases potential inju-
ries for oropharyngeal procedures prevents injuries in
this site. These devices increase the intraoral vision of
the tonsils and may prevent potential injuries in the lat-
eral oral comissure.
Tonsillectomy and adenotonsillectomy surgeries ac-
count for the most frequent malpractice complaints in
otorhinolaryngological procedures [12]. When the rates
of malpractice complaints following tonsillectomy or
adenoidectomy are evaluated (bleeding 17.5%, airway
burns 1.5%, burns 18.2%, related to consent 5.8%, re-
lated to medication 5.8%, residual tissue/recurrence 5.8%)
it is seen that burns are the most frequent malpractice
claims [1]. Another study states that while physicians
think that the perioral burn complication is 4%, parental
observation puts the figure to 14% [13]. The differences
between these data suggest that the reporting of perioral
burns at different stages is not being done adequately and

A Rare Complication: Perioral Burn Related to Electrocautery Use during Adenotonsillectomy
70
correctly. The evaluation of this complication as mal-
practice by physicians remains as a block against correct
reporting and data collection. We believe that informing
the patient and patient’s relatives about perioral burns as
complications in re-op information processes and consent
forms will overcome
4. Conclusion
There are a limited number of sound studies in literature
on perioral burn which is a possible complication of
adenotonsillectomy. Perioral burn can be a significant
complication that delays healing and that may leave
permanent marks. Protective barriers should be used;
careful surgical and observational measures should be
taken in order to prevent this anticipated complication.
Pre-op information talks and consent forms should in-
clude this possible complication.
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