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Management of oropharyngeal trauma in children
S R Schoem1, S S Choi, G H Zalzal
1Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA.
Insights
Oropharyngeal trauma in children requires careful evaluation for potential neurovascular injury. Admission decisions for pediatric oropharyngeal trauma should consider home distance and supervision reliability.
Area of Science:
- Pediatric Otolaryngology
- Emergency Medicine
- Trauma Surgery
Background:
- Oropharyngeal trauma in children presents unique diagnostic and management challenges.
- Prompt identification of potential complications is crucial for optimal patient outcomes.
Purpose of the Study:
- To define indications for hospital admission in pediatric oropharyngeal trauma.
- To identify necessary imaging studies and urgent interventions.
- To correlate clinical findings with the need for medical or surgical management.
Main Methods:
- Retrospective chart review of 26 pediatric patients with oropharyngeal trauma.
- Analysis of emergency department presentations, including history and physical examination findings.
- Evaluation of subsequent management and outcomes.
Main Results:
- Indications for admission included concern for neurologic/vascular injury, retropharyngeal free air/abscess, pneumomediastinum, and unreliable home supervision.
- Six patients required surgical intervention, including aspiration, drainage, neck exploration, and foreign body removal.
- No permanent vascular or neurologic injuries were reported in this cohort.
Conclusions:
- Oropharyngeal trauma can lead to palatal/pharyngeal wall injuries and retropharyngeal free air, rarely progressing to abscess or significant pneumomediastinum.
- Lateral oropharyngeal injuries warrant concern for neurovascular impairment, though mechanism and injury severity do not reliably predict sequelae.
- Admission for observation should be guided by factors like distance to hospital and home supervision, as neurovascular changes may be delayed.
Objective:
To determine the indications for admission, requisite imaging studies, and urgent medical or surgical intervention.
Design:
We retrospectively reviewed the charts of 26 children (age range, 5 months to 14 years) who were seen by the otolaryngology service in the emergency department at the Children's National Medical Center, Washington, DC, from 1985 to 1993 and who were diagnosed as having oropharyngeal trauma. We specifically looked for common findings in the history and physical examination on initial presentation to predict the necessary steps in evaluation and management.
Setting:
Tertiary care pediatric referral center.
Results:
Indications for admission were (1) concern about neurologic injury, (2) concern about vascular injury, (3) radiographic evidence of retropharyngeal free air or abscess, (4) pneumomediastinum, and (5) unreliable adult supervision at home. Six patients required surgery; 3 underwent retropharyngeal aspiration or incision and drainage procedures; 2 required neck explorations; and 1, who had an impaled foreign body in the parapharyngeal space, underwent surgical extraction. There were no vascular, neurologic, or other permanent injuries.
Conclusions:
Oropharyngeal trauma may result in palatal and posterior pharyngeal wall injury requiring closure of lacerations and management of retropharyngeal free air. Rarely does an injury lead to retropharyngeal abscess or significant pneumomediastinum. Lateral oropharyngeal injuries require increased concern about potential neurovascular impairment. However, neither the mechanism of injury nor the degree of injury correlates with the potential for neurovascular sequelae. Since neurovascular involvement may not become clinically apparent until days or weeks after the incident, admission for observation alone should be based on the distance from the patient's home to the hospital and on the level of reliable adult supervision. Indications for medical and surgical treatment of internal carotid artery thrombosis remain controversial.