bubble_chart Overview

Pharyngeal trauma is often caused by foreign body injury, iatrogenic injury, chemical corrosion, and burns. It can occur alone or is often accompanied by injuries to the oral cavity, larynx, neck, or esophagus.

bubble_chart Pathogenesis

External injuries of the mouth and pharynx. These include foreign body injuries (such as fish bones, bone fragments), iatrogenic injuries (such as endoscopy, tracheal intubation, nasogastric tube insertion, adenoid surgery), chemical burns, and thermal burns. Clinically, these are commonly seen in children who fall while holding objects like chopsticks, pencils, or toy handles in their mouths, resulting in injuries to the oral cavity and pharynx. Such injuries mostly involve simple soft tissue damage.

bubble_chart Clinical Manifestations

Trauma to the nasopharynx is often caused by bullets or shrapnel entering through pathways such as the nasal cavity, sinuses, orbits, or lateral neck. It can also result from facial or skull base fractures due to car accidents or industrial injuries. These injuries are typically severe, with significant bleeding. If blood flows into the respiratory tract, it can cause choking or asphyxia, while excessive blood loss may lead to shock. Some patients may also present with cerebrospinal fluid rhinorrhea.

Injuries to the oral cavity and oropharynx are commonly caused by children falling with hard objects in their mouths. Puncture wounds often occur in the soft palate, hard palate, posterior pharyngeal wall, lateral pharyngeal wall, or cheeks. These injuries may lead to submucosal bruising, hematomas, irregular muscle layer tears, or perforations. Improper management can result in retropharyngeal or lateral pharyngeal infections, leading to abscess formation.

Trauma caused by esophagoscopy often occurs in the pyriform fossa or below the cricopharyngeal muscle. Severe mucosal abrasions or perforations of the cervical esophagus can lead to upper mediastinitis or abscess formation, manifesting as high fever, retrosternal pain radiating to both scapulae, dyspnea, increased intrathoracic pressure, dysphagia, and subcutaneous emphysema.

In cases of thermal burns, chemical burns, or corrosive injuries to the pharynx, mucosal reactions typically appear within 2 hours, peak at 4–6 hours, and begin to subside after 12 hours. However, infection may subsequently develop. The severity of mucosal reactions can be classified into three degrees:

Degree I: Diffuse mucosal congestion and edema, resolving spontaneously within 3–5 days.

Degree II: Significant mucosal hemorrhage and edema, sometimes with serous blisters, erosions, and fibrinous pseudomembranes on the mucosal surface, accompanied by swollen adjacent lymph nodes. Symptoms usually subside in about 7–14 days.

Degree III: Often caused by chemical injuries, involving damage to the submucosal layer and surrounding muscle tissues, mucosal ulcers, deep necrosis, and prolonged inflammation lasting 3–4 weeks. After scab shedding and granulation tissue formation, scar connective tissue forms, leading to local stenosis or even atresia, which can impair swallowing and breathing.

bubble_chart Treatment Measures

I. First Aid Treatment

1. Hemostasis: For nasopharyngeal bleeding, posterior nasal packing may be used if necessary. For oropharyngeal or neck bleeding, vascular ligation can be performed to stop the bleeding.

2. Maintain airway patency: Suction out blood and secretions obstructing the local area. Tracheal intubation or tracheostomy may be performed if necessary. Hormone therapy can prevent and reduce edema.

3. Treat shock: Administer fluids, blood transfusions, and oxygen.

4. Provide intravenous or nasogastric nutrition.

5. Neutralization therapy: For strong acid burns, dilute with water within 2–4 hours post-injury, followed by gastric lavage with magnesium emulsion, aluminum hydroxide gel, or soapy water. Avoid sodium bicarbonate to prevent excessive gas production, which could impact the upper digestive tract. For strong alkali ingestion, use edible vinegar, 2% acetic acid, orange juice, or lemon juice for gastric lavage. After neutralization, administer milk, egg whites, or other edible oils orally.

II. Surgical Treatment

1. Remove foreign bodies.

2. Debridement and suturing

Due to the rich blood supply and strong infection resistance of the oral cavity, initial-stage (first-stage) debridement and suturing can still be performed 24–48 hours post-injury. Strive to suture the torn mucosa, muscles, and skin in layers. Local anesthesia is generally used, while general anesthesia is employed for children. If excessive local tissue loss requires repair, consider using 20–40% of the lateral tongue to create a transfer flap for suturing the defect. The anterior one-third (mobile portion) of the tongue should be sutured, while the remaining tongue wound can be covered with a thin skin graft to prevent adhesion to the flap and restriction of tongue movement.

III. Systemic Treatment

Administer tetanus antitoxin 1500–3000 IU and use antibiotics to control infection. If esophageal injury or perforation is suspected, administer high-dose antibiotics and strictly prohibit swallowing.