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December 1997

Management of Oropharyngeal Trauma in Children

Author Affiliations

From the Departments of Otolaryngology, Children's National Medical Center, George Washington University (Drs Schoem, Choi, and Zalzal), and Georgetown University Medical Center (Dr Grundfast), Washington, DC.

Arch Otolaryngol Head Neck Surg. 1997;123(12):1267-1270. doi:10.1001/archotol.1997.01900120011001

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.Arch Otolaryngol Head Neck Surg. 1997;123:1267-1270

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