Young children are vulnerable to orofacial burns, especially of the lips ( Fig 90.9 ) These full-thickness burns of the upper and lower lips and oral commissure usually involve mucosa, submucosa, muscles, nerves, and blood vessels The lesion usually has a pale, painless, well-demarcated, depressed center with surrounding pale gray tissue and erythematous border After a few hours, the wound margin extends and marked edema occurs Drooling is common The eschar separates in to weeks and bleeding may occur at this time; granulation tissue gradually fills the wound Scarring may produce lip eversion, microstomia, and loss of function Damage to facial or even carotid arteries may result in delayed hemorrhage Devitalization of deciduous and secondary teeth may occur FIGURE 90.9 Patient with electrical burns to the corner of the mouth after biting on an electrical cord (Courtesy of Evaline Alessandrini, MD.) Inadequately debrided burned or gangrenous tissue provides a medium for infection Staphylococcal, pseudomonal, and clostridial species are common pathogens in the extremities Streptococci and oral anaerobic organisms may infect mouth wounds Management and Diagnostic Studies The first step in emergency management ( Table 90.9 ) is to separate the victim from the current source The rescuer must be well insulated to avoid becoming an additional casualty If the current cannot be shut off, wires can be cut with a wood-handled ax or appropriately insulated wire cutters In cases of lightning, contact with the victim does not pose any threat to the rescuer, and treatment may be started immediately Any victim in cardiopulmonary arrest should be resuscitated promptly following the guidelines discussed in Chapters A General Approach to the Ill or Injured Child , Airway , and Cardiopulmonary Resuscitation Prolonged