Pharyngeal trauma in children – accidental and otherwise

Abstract

Pharyngeal perforation is an uncommon injury in children. Most reported cases to date have been secondary to instrumentation or penetrating wounds. Laceration to the pharyngeal wall may introduce air, secretions and bacteria into the parapharyngeal space and mediastinum and consequently has potentially life-threatening sequelae. The management of these injuries is controversial. We present a series of four children who suffered pharyngeal trauma, accidentally and otherwise, and discuss their management.We recommend a high index of suspicion of pharyngeal injury in all cases of oropharyngeal trauma and overnight admission to hospital for observation until an accurate diagnosis has been established. Non- accidental injury of the child must be seriously considered in all cases.

Penetrating pharyngeal injuries in children: trivial trauma leading to devastating complications

“…Children presenting to the emergency room with fever, irritability, poor feeding, drooling, neck pain and swelling, and a history of atypical trauma should alert the physician to the possibility of pharyngeal perforation [7,8]. A soft-tissue lateral film of the neck is a key investigation in the initial assessment of these patients [7][8][9][10]. An increase in width and the presence of air in the retropharyngeal space indicate perforating injury to the pharynx and warrant further investigations, such as chest radiographs, contrast studies, and endoscopy.…”

“…Stamm's gastrostomy or insertion of a nasogastric tube under vision are useful adjuvant procedures to maintain the nutritional status of these sick patients. Esophageal exclusion procedures are rarely indicated in children and are associated with significant morbidity [7,9,10]. Early administration of broad-spectrum antibiotics-a penicillinase-resistant penicillin combined with clindamycin and an aminoglycoside-is the cornerstone of surgical and nonsurgical management [1][2][3][7][8][9][10].…”

“…A CT scan of the neck and chest is helpful in early diagnosis of mediastinal abscess and empyema thoracis. Early drainage of mediastinal abscess is warranted, as untreated mediastinitis has a mortality of more than 50% [1,3,9,10].…”

“…Most of these injuries are innocuous and go unrecognized and unreported. However, life-threatening complications due to these apparently benign injuries can occur [1,2,9]. This report describes the experience of three children with penetrating injury to the pharynx following minor trauma.…”

“…Other rare causes include digital trauma during efforts at resuscitation, intraoral beverage bottle explosion, and injuries to the palate and pharynx due to impaction of a rigid object (such as a pencil) held in the mouth [4,8,9]. Most of these injuries are innocuous and go unrecognized and unreported.…”