Oropharyngeal trauma in children
- David W Roberson, MD
David W Roberson, MD
- Associate Professor
- Harvard Medical School
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Children often fall with objects in their mouths and may suffer trauma to the oropharynx. These injuries pose a significant diagnostic challenge because the vast majority will heal spontaneously without complications [1-4], but a small minority will develop deep neck infections or carotid artery injuries that cause major morbidity and mortality [5-10]. The approach to oropharyngeal blunt trauma relies on an assessment of the oropharyngeal wound, a rational use of diagnostic tools, primarily noninvasive radiologic techniques, and surgical intervention in selected patients.
This review covers the evaluation and management of wounds to the hard and soft palate, tonsils, and posterior pharyngeal walls. Dental and tongue injuries are discussed separately. (See "Evaluation and management of dental injuries in children" and "Evaluation and repair of tongue lacerations".)
Oropharyngeal injuries account for an estimated 1 percent of all pediatric trauma . A common mechanism involves a toddler or preschool child falling with an object in the mouth or having an item pushed into their mouth by a playmate or caregiver. Commonly reported objects include writing instruments (eg, pen, pencil), toothbrushes, Popsicle sticks, lollipops, eating utensils, and drinking straws [2,12]. Infrequently, the trauma may result from a blind finger sweep by a caregiver during a choking episode .
ANATOMY AND PATHOPHYSIOLOGY
The oropharynx consists of the following structures:
●Soft palate, uvula above
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- ANATOMY AND PATHOPHYSIOLOGY
- Internal carotid artery injury (ICA)
- Deep neck space infection
- CLINICAL FEATURES
- Physical examination
- - Wound characteristics
- - Associated physical findings
- Laboratory evaluation
- Radiographic imaging
- - Plain radiographs of the neck and chest
- - Carotid ultrasound with oculoplethysmography
- - Computed tomography angiography (CTA)
- - Magnetic resonance angiography (MRA)
- - Carotid artery angiography (CAA)
- EVALUATION AND MANAGEMENT
- Initial stabilization
- Approach to diagnosis and management
- - High risk injury
- - Moderate risk injury
- - Low risk injury
- Wound management
- - Laceration repair
- - Tetanus prophylaxis
- - Empiric antibiotic therapy
- Child protection
- Deep neck infection
- Cerebral vascular thrombosis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Clinical features
- Approach to evaluation and management
- Wound care
- Follow-up instructions