Diagnosis of Penetrating Injuries of the Pharynx and Esophagus in the Severely Injured Patient

Ahmed, Naveed; Massier, Christian; Tassie, James; Whalen, James; Chung, Raphael S.

doi:10.1097/ta.0b013e31817e611d

Cited by 34 publications

(32 citation statements)

References 9 publications

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“…It has been demonstrated that contrast swallow studies are less sensitive in detecting hypopharyngeal injuries as compared with esophageal injury and flexible nasoendoscopy or video endoscopy should be part of the ''trauma surgeon's armamentarium.'' 51,53 …”

Section: Annotated Text For the Algorithmmentioning

confidence: 98%

Western Trauma Association Critical Decisions in Trauma

Sperry

Moore

Coimbra

et al. 2013

Journal of Trauma and Acute Care Surgery

158

114

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T his is a recommended algorithm of the Western Trauma Association for the management of penetrating neck trauma that has penetrated the platysma muscle of the neck. Because of the paucity of recent prospective randomized trials on the evaluation and management of penetrating neck injury, the current algorithm and recommendations are based on available published prospective cohort, observational, and retrospective studies and the expert opinion of the Western Trauma Association members. The algorithm (Fig. 1.) and accompanying text represents a safe and reasonable approach to this difficult injury type and attempts to incorporate the advent of recent advances in radiographic screening and selective or expectant management practice. We recognize that there will be variability in decision making, local resources, institutional consensus, and patient-specific factors that may require deviation from the algorithm presented. This annotated algorithm is meant to serve as a basis from which protocols at individual institutions can be developed or serve as a quick bedside reference for clinicians. The algorithm contains letters A through J, which correspond to the lettered text. Their purpose is to succinctly navigate the reader thru the algorithm and discuss those points, which require further elucidation or where data are lacking. 1Y3

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Section: Annotated Text For the Algorithmmentioning

confidence: 98%

Western Trauma Association Critical Decisions in Trauma

Sperry

Moore

Coimbra

et al. 2013

Journal of Trauma and Acute Care Surgery

158

114

View full text Add to dashboard Cite

show abstract

“…The quoted sensitivity of a contrast swallow ranges from 48 to 100%, with poorer results for higher lesions including the hypopharynx 38,39 . Flexible or rigid oesophagoscopy has better accuracy for these higher lesions with a sensitivity of up to 100% 39,40 . In addition, direct oesophagoscopy is less technically challenging to perform than a contrast swallow in patients who are intubated and can also be undertaken in unstable patients or performed intra‐operatively.…”

Section: Investigation Into Suspected Pharyngo‐oesophageal Injurymentioning

confidence: 99%

“…38,39 Flexible or rigid oesophagoscopy has better accuracy for these higher lesions with a sensitivity of up to 100%. 39,40 In addition, direct oesophagoscopy is less technically challenging to perform than a contrast swallow in patients who are intubated and can also be undertaken in unstable patients or performed intra-operatively. One advantage of a contrast swallow over oesophagoscopy, however, is that the size and extent of a pharyngeal or oesophageal leak can be assessed; this information has been used in some centres to determine how oesophageal injuries are managed.…”

Section: Investigation Into Suspected Pharyngo-oesophageal Injurymentioning

confidence: 99%

An evidence based review of the assessment and management of penetrating neck trauma

Burgess

Dale

Almeyda

et al. 2012

Clinical Otolaryngology

100

146

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Clin. Otolaryngol. 2012, 37, 44–52 Background: Although relatively uncommon, penetrating neck trauma has the potential for serious morbidity and an estimated mortality of up to 6%. The assessment and management of patients who have sustained a penetrating neck injury has historically been an issue surrounded by significant controversy. Objectivesof review: To assess recent evidence relating to the assessment and management of penetrating neck trauma, highlighting areas of controversy with an overall aim of formulating clinical guidelines according to a care pathway format. Type of review: Structured, non‐systematic review of recent medical literature. Search strategy: An electronic literature search was performed in May 2011. The Medline database was searched using the Medical Subject Headings terms ‘neck injuries’ and ‘wounds, penetrating’ in conjunction with the terms ‘assessment’ or ‘management’. Embase was searched with the terms ‘penetrating trauma’ and ‘neck injury’, also in conjunction with the terms ‘assessment’ and ‘management’. Results were limited to articles published in English from 1990 to the present day. Evaluation method: Abstracts were reviewed by the first three authors to select full‐text articles for further critical appraisal. The references and citation links of these articles were hand‐searched to identify further articles of relevance. Results: 147 relevant articles were identified by the electronic literature search, comprising case series, case reports and reviews. 33 were initially selected for further evaluation. Conclusions: Although controversy continues to surround the management of penetrating neck trauma, the role of selective non‐operative management and the utility of CT angiography to investigate potential vascular injuries appears to be increasingly accepted.

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“…If there is any suspicion of hypopharyngeal or esophageal injury such as in penetrating injuries to the neck or torso, contrasted radiologic studies and endo- scopy are indicated. Fiberoptic endoscopic examination is the best screening tool for recognition of a possible hypopharyngeal mucosal violation, and is necessary if suspicion is high, as contrasted radiologic studies frequently miss hypopharyngeal injuries [4][5][6]. Endoscopic examination will also reveal the exact size and location of the injury, which is necessary to determine further workup and management.…”

Section: Discussionmentioning

confidence: 99%

Pharyngeal trauma: Two unique case reports

Colby¹,

Moore²

2012

OJCD

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The neck is a complex pathway for numerous critical structures and is defined by layers of fascial planes and spaces. Traumatic interruption of these planes can occur with injury to any of the mucosal structures within the head and neck, and is often seen as a consequence of pharyngeal injury. Here, the identification and management of two interesting and unique cases of penetrating oropharyngeal trauma are discussed: oropharyngeal trauma following abuse, and a self-inflicted pharyngeal wound with subsequent foreign body ingestion. We also review the literature regarding diagnosis, treatment, and management of traumatic pharyngeal perforation, and discuss possible complications.

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Diagnosis of Penetrating Injuries of the Pharynx and Esophagus in the Severely Injured Patient

Cited by 34 publications

References 9 publications

Western Trauma Association Critical Decisions in Trauma

Western Trauma Association Critical Decisions in Trauma

An evidence based review of the assessment and management of penetrating neck trauma

Pharyngeal trauma: Two unique case reports

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