Management of External Penetrating Injuries into the Hypopharyngeal-cervical Esophageal Funnel

Abstract

Overall, the consequences of an external penetrating injury become more serious in the descending levels of the funnel formed by the hypopharynx and cervical esophagus. Injuries located in the upper portion of the hypopharynx can be routinely managed without surgical intervention. Neck exploration and adequate drainage of the deep neck spaces are, however, mandatory for all penetrating injuries into the cervical esophagus and most injuries into the lower portion of the hypopharynx.

Pharyngeal trauma: Two unique case reports

“…Multiple studies of hypopharyngeal and cervical esophageal wounds have found that antibiotics within 12 -24 hours from the time of injury are vital for the best possible outcome [1][2][3]. Pain is the most common presenting symptom of pharyngeal perforation, as was with our first case.…”

“…Large perforations or perforations that involve the esophageal inlet or esophagus exclusively have been found to be best treated surgically [7,9]. Stanley et al [3] in a study of 70 patients with pharyngeal-cervical esophageal injuries reported no difference in outcome between observation and surgery with an injury located in the hypopharynx above the arytenoid cartilage of the larynx. However, 22% of patients with pharyngeal injuries below the level of the arytenoids and 39% of patients with cervical esophageal injuries developed deep infections or fistula.…”

Management of penetrating neck injuries

“…More than 90 per cent of patients survive when the diagnosis is made within 24 h, but thereafter the survival rate drops quickly 20 fatal than oesophageal lesions 21,22 . Pharyngeal lesions can usually be treated conservatively with antibiotics alone, whereas oesophageal lesions needs surgery 22 -24 .…”

Chronic Pyriform Sinus-Pleural-Mediastinal Fistula Secondary to an Internal Penetrating Trauma by a Toothbrush

“…The pyriform sinus is well covered with muscle, which is comparatively resistant to penetration because of its strong extensibility [2]. Therefore, the violent impact of a toothbrush in our case led to internal penetrating injury to the pyriform sinus.…”

“…Surgical intervention includes neck drainage, chest or upper mediastinal drainage, and transoral endoscopic or surgery repair. Currently, it is recommended that conservative treatment is suitable for the following patients suffering from pyriform sinus perforation [2]- [5]: 1) patients whose perforation is quickly diagnosed and lasts less than 12 hours; 2) patients with a small perforation (<2 cm) located in the cervical esophagus or hypopharynx; 3) patients without symptoms or with mild symptoms and a lack of complications; 4) patients taken nothing orally since the injury; and 5) patients whose condition could not tolerate an operation. A large perforation (>2 cm) lasting more than 12 hours or any complications require exploration and repair by operation if possible and adequate drainage.…”