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Penetrating injury of oropharynx — Clinical Guidelines

Overview

Penetrating injury of the oropharynx typically results from sharp objects causing direct trauma to the throat, potentially leading to airway compromise, hemorrhage, and neurological complications depending on the extent and location of injury. 1

Diagnosis

Clinical Presentation: Airway obstruction, dysphagia, hematemesis, and signs of shock.

Imaging: CT or MRI to assess extent of injury, presence of foreign bodies, and associated injuries.

Neuroendocrine Assessment: Consider evaluation for neuroendocrine dysfunction, especially in cases with brain involvement, including thyroid function tests and cortisol levels. 1

Management

Airway Management: Immediate securing of the airway, possibly requiring intubation or cricothyrotomy in severe cases.

Surgical Intervention: Removal of foreign bodies and repair of tissue damage; may involve sternotomy for cardiac involvement if present. 2

Hemodynamic Support: Fluid resuscitation and blood transfusion as needed for hemorrhage control.

Neuroendocrine Replacement Therapy: Hormonal replacement for thyroid dysfunction and hydrocortisone for hypocortisolism if neuroendocrine dysfunction is identified. 1

Special Populations

Pediatrics: Anesthesia management should avoid suxamethonium due to risk of malignant hyperthermia and focus on techniques without muscle relaxants, extubating under deep anesthesia. 3

Key Recommendations

Secure the airway immediately upon presentation due to high risk of obstruction. (Evidence: Moderate 1)

Perform imaging (CT/MRI) to assess extent of injury and guide surgical intervention. (Evidence: Moderate 1)

Evaluate for and manage neuroendocrine dysfunction post-injury, particularly in cases with brain involvement, including hormonal replacement therapy. (Evidence: Weak 1)

Avoid suxamethonium in pediatric patients with penetrating oropharyngeal injuries to prevent complications. (Evidence: Expert opinion 3)

References

1 Loggini A, Tangonan R, El Ammar F, Mansour A, Kramer CL, Lazaridis C et al.. Neuroendocrine Dysfunction in the Acute Setting of Penetrating Brain Injury: A Systematic Review. World neurosurgery 2021. link 2 Rupprecht H, Ghidau M. Penetrating nail-gun injury of the heart managed by adenosine-induced asystole in the absence of a heart-lung machine. Texas Heart Institute journal 2014. link 3 Seidel J, Dorman T. Anesthetic management of preschool children with penetrating eye injuries: postal survey of pediatric anesthetists and review of the available evidence. Paediatric anaesthesia 2006. link

Penetrating injury of oropharynx