Facial burns as functional trauma: integrating expression, identity and long-term recovery: A narrative review

Advances in acute burn care have improved survival, shifting focus toward long-term functional recovery. Facial burns present a distinct clinical challenge due to the concentration of ocular, oral, respiratory, and expressive functions within a highly visible anatomical region. This narrative review synthesises functional and psychosocial literature to examine facial burns as trauma that disrupts dynamic facial movement, communication, and participation, and to evaluate limitations in current outcome frameworks. The face supports ocular protection, articulation, alimentation, airway patency, and non-verbal signalling. Contracture patterns, including microstomia, ectropion, nasal distortion, and midfacial contracture, may impair both mechanical function and expressive range. Recovery is typically longitudinal and iterative, addressing evolving distortion rather than restoring pre-injury dynamics. Even subtle restrictions of facial movement may alter speech clarity, eye contact, and self-recognition, with consequences extending beyond visible scarring. Existing outcome measures, including body image scales, burn-specific health instruments, and isolated physical metrics, do not adequately capture the interaction between structural repair, expressive mobility, and communicative participation. Recognition of facial burns as functional trauma supports the need for facial-specific composite outcome models and coordinated multidisciplinary care to optimise long-term recovery.