bubble_chart Overview

Mechanical trauma to the pharynx is often caused by external direct violence, such as war injuries, traffic accidents, industrial accidents, or suicide. It can also result from internal trauma, such as surgical injuries or foreign body injuries. External stab or incised wounds of the pharynx are commonly found in the oropharynx and laryngopharynx, with wounds typically located between the hyoid bone and thyroid cartilage. Incised wounds from sharp objects like knives are usually transverse, while stab wounds, incised wounds, and lacerations caused by sharp weapons are often penetrating wounds with small skin entry points that penetrate deeply inward or become through-and-through wounds. Contusions, caused by blunt force trauma, can lead to deep tissue rupture, and blast injuries often result in extensive damage to neck tissues.

bubble_chart Clinical Manifestations

Pharyngeal contusion is mainly characterized by localized pain, which worsens during speaking, swallowing, and coughing. Sharp instrument injuries may present with wound bleeding, subcutaneous emphysema, and hemoptysis. If major blood vessels are injured, it can lead to shock or death due to blood loss. Blood flowing into the larynx and trachea can cause coughing, difficulty breathing, etc. Contusions or blast injuries, or those accompanied by external laryngeal trauma, may result in pharyngeal edema, hematoma, or laryngeal cartilage fractures, leading to respiratory distress. Penetrating wounds can cause saliva leakage from the wound and difficulty swallowing. Secondary infection of the wound may lead to systemic symptoms such as fever.

Examination: First, pay attention to the patient's general condition, such as breathing, pulse, and blood pressure. Internal puncture wounds in the pharynx often involve the posterior oropharyngeal wall or soft palate, with bleeding, hematoma, and mucosal rupture in the pharynx. Submucosal ecchymosis of the uvula appears as a bluish-purple swelling. Neck contusions commonly present with neck swelling or bruising. If accompanied by hemorrhage and emphysema in the neck soft tissues, the neck may appear enlarged. If combined with laryngeal contusion, there may be laryngeal cartilage fractures or dislocation. Although sharp instrument wounds are small, the injury is deep, often complicated by subcutaneous emphysema and hemoptysis. Incised wounds are commonly seen in suicidal neck-cutting cases, mostly transverse and located in the thyrohyoid membrane or thyroid cartilage. After the incision, the wound often expands due to the contraction of the platysma and anterior neck muscles. In severe cases of open pharyngeal or laryngeal trauma, the pharyngeal wall and internal laryngeal structures may be visible through the wound. Gunshot or blast injuries often involve extensive trauma, accompanied by damage to major neck vessels, cervical vertebrae, cervical trachea, or esophagus. For wounds near major neck vessels, examination should be cautious. Adequate lighting and emergency hemostatic equipment must be prepared. Otherwise, blood clots or foreign bodies in the wound should not be hastily removed, nor should the wound be probed with instruments, to avoid causing massive hemorrhage.

bubble_chart Treatment Measures

Pharyngeal contusions are primarily treated conservatively, with the patient advised to rest in bed and apply local cold or hot compresses. For patients with open pharyngeal trauma, the principles are to stop bleeding, relieve asphyxia, and treat shock.

1. Management of bleeding: Severe bleeding may occur when larger blood vessels in the neck are injured. Emergency treatment for massive bleeding involves digital compression of the common carotid artery to temporarily stop bleeding and reduce blood loss. Local pressure on the wound can also stop bleeding, but care should be taken to prevent packing materials from entering the pharynx and causing respiratory distress. Once the patient's general condition improves or conditions for hemostasis are met, the wound should be thoroughly examined to identify active bleeding points. Smaller blood vessels can be clamped and ligated, while larger arterial or venous lacerations may be sutured with fine silk thread. Vascular anastomosis may be performed if necessary.

2. Relief of respiratory distress: In emergencies involving open pharyngeal wounds, a tracheostomy tube can be inserted into the wound or a suction catheter can be introduced into the pharyngeal cavity to remove secretions, blood clots, and foreign bodies from the airway, ensuring its patency. If the trauma is extensive and involves the larynx, chest, or abdomen, a tracheostomy should be performed.

3. Prevention and treatment of shock: Preventive measures should be taken before shock symptoms appear. For patients with excessive bleeding, immediate blood transfusion, fluid infusion, and the use of cardiotonic agents are necessary. Keep the patient warm and in a head-low position.

4. Wound management: After repeatedly irrigating the wound with saline or hydrogen peroxide, debride and suture it. The anatomical structure should be restored as much as possible. Pharyngeal mucosa should be sutured in alignment whenever possible. Larger defects can be repaired with adjacent tissues, followed by layered suturing. For late-stage (third-stage) pharyngeal scar stenosis, treatments such as oral dilation, laser ablation, drug injection, or lateral pharyngotomy may be performed.

5. Nutritional support: For patients whose pharyngeal wounds affect eating, a nasogastric tube should be inserted for liquid feeding.

6. Management of foreign bodies: Superficial or easily removable foreign bodies, or those far from major blood vessels, can be extracted during surgery. If the foreign body is near large blood vessels or pulsates with the carotid artery, the risks and complexity of the surgery should be considered, and removal should only be attempted after thorough preparation.

Additionally, antibiotics should be administered to prevent infection, and measures should be taken to prevent scar stenosis and manage complications.