Blunt Pharyngoesophageal Injuries: Current Management Strategies

Abstract

Pharyngoesophageal injuries are rare following blunt trauma. Only a quarter require a neck exploration and this decision appears to be dictated by the injury burden. Selective non-operative management based on clinical status seems to be feasible and is not associated with increased mortality.

Traumatic Hypopharyngeal Perforation from Football Helmet Chinstrap

“…4 The majority of hypopharyngeal perforations presented to trauma centers are after iatrogenic, penetrating, or blunt trauma to the neck. [1][2][3][4][5][6] Blunt trauma is responsible for less than 2% of hypopharyngeal perforations with most following a fall, blunt assault, motor vehicle or motorcycle collisions, or direct impact during sports activities. 3,[6][7][8][9][10] Perforations are most likely to occur at the hypopharyngealesophageal junction.…”

“…[1][2][3][4][5][6] Blunt trauma is responsible for less than 2% of hypopharyngeal perforations with most following a fall, blunt assault, motor vehicle or motorcycle collisions, or direct impact during sports activities. 3,[6][7][8][9][10] Perforations are most likely to occur at the hypopharyngealesophageal junction. This area, known as Killian's dehiscence, lacks the longitudinal muscle fibers of the inferior pharyngeal constrictor and consists solely of mucosa and serosa.…”

“…19,21 Recently, a trend toward nonoperative treatment has been emerging which includes broad spectrum antibiotics, NPO status, parenteral nutrition, and follow-up imaging studies. 3,18,22 Criteria to select patients for nonoperative management are not well defined. Some have recommended this approach for perforations under 2 centimeters in length, presentation within 24 hours, no oral intake in the interval between injury and presentation to the hospital, and no signs of systemic infection or injury superior to the arytenoid cartliage.…”

“…2,4,16 Overall, the management and treatment of hypopharyngeal perforation varies depending on the severity of the injury, as numerous factors influence treatment decisions: time of clinical presentation, physical signs and symptoms, degree of extravasation of contrast media, and the location and size of the perforation. [1][2][3]6,10,15,18,19,22…”

“…Hypopharyngeal perforation is a rare but potentially serious injury typically resulting from instrumentation or external penetrating trauma. [1][2][3] Perforation following blunt trauma is even more rare. 1 Due to the nature of this injury and the serious complications that can arise, prompt and proper diagnosis is key for a good patient outcome and prognosis.…”