Oral and Oropharyngeal Manifestations of Child Abuse: A State-of-the-Art Review

Child abuse carries significant morbidity and mortality, with children younger than 1 year being most vulnerable. Oral cavity and oropharyngeal injuries are rare in infants, particularly among those who are pre-mobile, and are considered sentinel injuries, as they may precede more severe physical abuse. It is vital that clinicians without specialty training in child abuse, including otolaryngologists, recognize oral manifestations of child physical abuse.

Articles were identified by searching PubMed. Conference proceedings were checked for relevant invited lectures and unpublished case presentations. Lastly, consultations with the Child Protection Team at our institution involving oropharyngeal injuries were reviewed to generate case examples.

Other than restricting the articles searched to pediatric patients, no exclusion or inclusion criteria were used.

Oral manifestations of physical abuse include frenula injury, sublingual hematoma, lacerations and abrasions to the oral cavity, oral cavity bruising and bleeding, as well as injury to the pharynx and hypopharynx, among other presentations. Standardized recommendations exist to guide the assessment for clinically occult but co-occurring injuries in infants and young children presenting with oral injury suspicious for abuse.

Timely recognition of oral manifestations of child abuse is imperative to prevent recurrent injury and death. Otolaryngologists who provide care to pediatric patients should become familiar with their local resources that can assist with the medical evaluation of suspected child abuse.