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Pediatric penetrating head and neck trauma
1Division of Otolaryngology, Emory University, Atlanta, GA.
Insights
Penetrating head and neck trauma in children is rare but serious. This study of 21 pediatric patients shows most survive with minimal disability, highlighting effective management strategies for these critical injuries.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Otolaryngology
Background:
- Penetrating head and neck trauma in children presents unique challenges.
- These injuries are uncommon but can be life-threatening, requiring specialized management.
- Understanding injury patterns and outcomes is crucial for improving pediatric care.
Purpose of the Study:
- To review the characteristics and outcomes of pediatric patients with penetrating head and neck trauma.
- To identify significant injuries and complications associated with these traumas.
- To highlight management strategies and differences compared to adult patients.
Main Methods:
- Retrospective chart review of 21 pediatric patients with penetrating face or upper neck injuries.
- Analysis of injury mechanisms (gunshot, stab wounds), patient demographics, and injury types.
- Evaluation of complications, treatment protocols, and patient outcomes, including mortality and permanent disability.
Main Results:
- The study included 21 patients (17 males, 4 females) aged 32 weeks gestation to 19 years.
- Common injury mechanisms included 15 gunshot wounds, 1 shotgun injury, and 5 stab wounds.
- Significant injuries involved vascular (7), central nervous system (6), ocular (5), airway (3), facial nerve (2), esophagus (1), and pneumothorax (2); 3 deaths occurred.
Conclusions:
- The majority of pediatric patients with penetrating head and neck trauma survive with minimal permanent disability.
- Effective management protocols can lead to favorable outcomes despite the severity of injuries.
- A unique case of intrauterine gunshot wound underscores the spectrum of pediatric trauma encountered.
Abstract:
Penetrating head and neck trauma in children causes uncommon and potentially life-threatening injuries. We reviewed the charts of 21 patients who sustained penetrating injuries to the face or upper neck. Seventeen males and 4 females, aged 32 weeks' gestation to 19 years (mean = 10.2 years) comprised the study population. There were 15 gun-shot wounds, 1 shotgun injury, and 5 stab wounds. Significant problems included 7 vascular injuries, 6 central nervous system injuries, 5 ocular injuries, 3 airway compromises, 2 facial nerve injuries, 1 cervical esophageal penetration, and 2 cases of pneumothorax. Three deaths occurred, but the majority of the patients survived and sustained minimal permanent disability. Included in this review is a unique case of an intrauterine gunshot wound to the face at approximately 32 weeks' gestation. The treatment protocol, differences from adult patients, and management highlights are reviewed.