Evaluation and Management of Pediatric Oropharyngeal Trauma

Abstract

To examine the clinical factors that influence medical decision making in children with oropharyngeal trauma. Design: Retrospective chart review (spanning 6 years). Setting: Tertiary care children's hospital. Patients: One hundred seven consecutive children with traumatic oropharyngeal injuries. Interventions: Computed tomographic angiography (CTA) (n = 52), surgical therapy (n = 16), inpatient admission (n=44), and antibiotic administration (n=77). Main Outcome Measures: The likelihood of a patient undergoing each of the 4 interventions and having positive radiographic findings or clinical complications was assessed with respect to the following clinical factors: (1) age, (2) sex, (3) mechanism of injury, (4) site of injury, (5) wound severity (3-point scale), and (6) otolaryngology consultation. Results: The following factors were significantly associated with an increased likelihood of a patient undergoing CTA to rule out occult internal carotid artery damage: (1) injury to the lateral soft palate, (2) high wound severity score, and (3) otolaryngology consultation. Radiographic abnormalities (including free air, parapharyngeal edema, and hematoma) were present in 16 (31%) of 52 CTAs but were not associated with any specific clinical factors. Patients with more severe wounds were more likely to undergo CTA, go to the operating room, receive antibiotics, and be admitted to the hospital but were not more likely to have positive CTA findings or an adverse clinical outcome. Conclusions: We were unable to identify any clinical factors that would help predict which children with oropharyngeal trauma are at high risk of developing neurologic sequelae. Radiographic screening for vascular injury in children with oropharyngeal trauma remains controversial.

Incidence of Morbidity From Penetrating Palate Trauma

“…If patients from our cohort are added to published data, it could be presumed that the incidence of neurologic sequelae is 0 of 513. 2,3,[5][6][7]25,26 Our results highlight a low incidence of infection, and the rate we report is lower than other published data on the subject. 3,7 The majority of our patients were treated with antibiotics, and we cannot directly comment on whether antibiotics are beneficial.…”

“…2,3,[5][6][7]25,26 Our results highlight a low incidence of infection, and the rate we report is lower than other published data on the subject. 3,7 The majority of our patients were treated with antibiotics, and we cannot directly comment on whether antibiotics are beneficial. It is possible that the low incidence of infection is because of the use of antibiotics, but it is notable that no infections developed among the subset of patients who were treated expectantly without the use of antibiotics.…”

“…Our data set is similar to those of previous studies on the basis of age and gender distribution and with a preponderance of injury to the lateral soft palate. 7 Several limitations of our study deserve mention. The retrospective na-ture brings with it concerns for missing data and the need to interpret what is written in the record.…”

Delayed internal carotid artery occlusion and paralysis after oral trauma

“…It is also characteristic that it takes time from the injury to the appearance of the symptom (3-60 h). 1,3 In our case, the time from injury to symptom appearance was several hours, and it seemed to embolize in the periphery.…”

“…Symptoms may develop when the thrombus is formed, causing emboli in the periphery, or when the thrombus itself reaches distally extensively from the internal carotid artery, or if anatomic abnormalities have originally been observed. It is also characteristic that it takes time from the injury to the appearance of the symptom (3–60 h) 1,3 . In our case, the time from injury to symptom appearance was several hours, and it seemed to embolize in the periphery.…”