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Pediatric oropharyngeal trauma: what is the role of CT scan?
Scott E Brietzke1, Dwight T Jones
1Boston Children's Hospital, Boston, MA, USA. SEBrietzke@msn.com
Insights
Cervical CT angiography (CTA) can effectively screen for severe complications in pediatric oropharyngeal trauma (OPT), including rare but serious carotid injuries. This imaging technique aids in evaluating children with OPT, potentially preventing devastating outcomes.
Area of Science:
- Pediatric Trauma
- Medical Imaging
- Otorhinolaryngology
Background:
- Pediatric oropharyngeal trauma (OPT) is common, with rare but severe complications like carotid injury and deep tissue infections.
- Cervical CT angiography (CTA) is widely available and may improve OPT patient evaluation.
Purpose of the Study:
- To evaluate the utility of cervical CT angiography (CTA) in identifying severe complications of pediatric oropharyngeal trauma (OPT).
- To assess the effectiveness of CT scans in detecting free air and carotid injuries in OPT patients.
Main Methods:
- Retrospective review of 23 pediatric patients with OPT (1997-2003).
- Systematic literature review on CT scan use for OPT evaluation.
- Extrapolation of data from general trauma literature on CTA for carotid injury detection.
Main Results:
- CT demonstrated superior detection and localization of free air compared to other methods.
- Literature review showed a lack of data on CT use for OPT evaluation.
- Trauma literature suggests helical CTA has high sensitivity and specificity for detecting carotid injury.
Conclusions:
- Routine cervical CT with contrast can aid in evaluating pediatric oropharyngeal trauma patients for severe complications.
- Further prospective data collection on CT's ability to detect carotid injuries is needed but may be challenging.
Objectives/Hypothesis:
Pediatric oropharyngeal trauma (OPT) is a common injury in children with rare, but at times severe complications including carotid injury and dissection of air/micro-organisms into the deep tissues of the neck or chest. Cervical CT scan with contrast (CT angiography (CTA)) is nearly universally available and may enhance the evaluation of OPT patients by screening for these potentially devastating complications.
Study Design:
Retrospective record review, systematic review of the literature.
Methods:
Twenty-three patients diagnosed with OPT from 1997 to 2003 at Boston Children's Hospital were identified by database review. Records were reviewed for site and mechanism of injury, use of diagnostic studies, management, and outcomes. Results were compared to previously published reports. The current literature was reviewed to assess the level of evidence pertaining to the evaluation of OPT patients with CT scan. An extrapolation was made to the general trauma literature to further evaluate the ability of CT angiography to detect carotid injury.
Results:
Demographics and mechanism of injury in the current series were unchanged from previous reports. CT demonstrated superior detection and localization of free air. Systematic review of OPT literature revealed data on the use of CT scan as evaluation tool were lacking. Extrapolations to the trauma literature strongly indicate helical CTA has high sensitivity and specificity in detecting carotid injury.
Conclusions:
Pediatric oropharyngeal trauma is a common injury with rare, but severe complications. The routine use of CT scan with contrast may assist in the evaluation of these patients to detect injuries that could lead to severe complications. Collection of prospective data on the ability of CT scan to detect carotid injuries is needed but may not be feasible.
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