Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Oropharyngeal trauma in children

David W Roberson, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


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 [11]. 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 [12].


The oropharynx consists of the following structures:

Soft palate, uvula above

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 11, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Radkowski D, McGill TJ, Healy GB, Jones DT. Penetrating trauma of the oropharynx in children. Laryngoscope 1993; 103:991.
  2. Brietzke SE, Jones DT. Pediatric oropharyngeal trauma: what is the role of CT scan? Int J Pediatr Otorhinolaryngol 2005; 69:669.
  3. Schoem SR, Choi SS, Zalzal GH, Grundfast KM. Management of oropharyngeal trauma in children. Arch Otolaryngol Head Neck Surg 1997; 123:1267.
  4. Ratcliff DJ, Okada PJ, Murray AD. Evaluation of pediatric lateral oropharyngeal trauma. Otolaryngol Head Neck Surg 2003; 128:783.
  5. Suskind DL, Tavill MA, Keller JL, Austin MB. Management of the carotid artery following penetrating injuries of the soft palate. Int J Pediatr Otorhinolaryngol 1997; 39:41.
  6. Windfuhr JP. Aneurysm of the internal carotid artery following soft tissue penetration injury. Int J Pediatr Otorhinolaryngol 2001; 61:155.
  7. Joseph MM, Lewis S. Stroke after penetrating trauma of the oropharynx. Pediatr Emerg Care 2002; 18:179.
  8. Palmer AL, Strain JD, Henry DB, et al. Postanginal sepsis after oropharyngeal trauma. Pediatr Infect Dis J 1995; 14:249.
  9. Kaplan DM, Fliss DM, Peiser Y, et al. Internal jugular vein thrombosis in a child due to a 'pencil point injury' of the palate. Int J Pediatr Otorhinolaryngol 1998; 44:183.
  10. Pierrot S, Bernardeschi D, Morrisseau-Durand MP, et al. Dissection of the internal carotid artery following trauma of the soft palate in children. Ann Otol Rhinol Laryngol 2006; 115:323.
  11. Chauhan N, Guillemaud J, El-Hakim H. Two patterns of impalement injury to the oral cavity: Report of four cases and review of literature. Int J Pediatr Otorhinolaryngol 2006; 70:1479.
  12. Soose RJ, Simons JP, Mandell DL. Evaluation and management of pediatric oropharyngeal trauma. Arch Otolaryngol Head Neck Surg 2006; 132:446.
  13. Hengerer AS, DeGroot TR, Rivers RJ Jr, Pettee DS. Internal carotid artery thrombosis following soft palate injuries: a case report and review of 16 cases. Laryngoscope 1984; 94:1571.
  14. Deutsch MD, Kriss VM, Willging JP. Distance between the tonsillar fossa and internal carotid artery in children. Arch Otolaryngol Head Neck Surg 1995; 121:1410.
  15. Naidoo S. A profile of the oro-facial injuries in child physical abuse at a children's hospital. Child Abuse Negl 2000; 24:521.
  16. Bolz WE, Brouwer HG, Schoenmakers CH. Measurement of HbF concentration for diagnosing a case of Munchausen by proxy syndrome. J Pediatr 2006; 148:145.
  17. Randall DA, Kang DR. Current management of penetrating injuries of the soft palate. Otolaryngol Head Neck Surg 2006; 135:356.
  18. Hennelly K, Kimia A, Lee L, et al. Incidence of morbidity from penetrating palate trauma. Pediatrics 2010; 126:e1578.
  19. Hellmann JR, Shott SR, Gootee MJ. Impalement injuries of the palate in children: review of 131 cases. Int J Pediatr Otorhinolaryngol 1993; 26:157.