Blunt Pharyngoesophageal Injuries: Current Management Strategies

Author:

Barmparas G.1,Navsaria P. H.2,Serna-Gallegos D.1,Nicol A. J.2,Edu S.2,Sayari A. A.2,Margulies D. R.1,Ley E. J.1

Affiliation:

1. Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA

2. Department of Surgery, Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

Abstract

Background: Blunt pharyngoesophageal injuries pose a management challenge to the trauma surgeon. The purpose of this study was to explore whether these injuries can be managed expectantly without neck exploration. Methods: The National Trauma Databank datasets 2007–2011 were reviewed for blunt trauma patients who sustained a pharyngeal injury, including an injury to the cervical esophagus. Patients who survived over 24 h and were not transferred from other institutions were divided into two groups based on whether a neck exploration was performed. Outcomes included mortality and hospital stay. Results: A total of 545 (0.02%) patients were identified. The median age was 18 years and 69% were male. Facial fractures were found in 16%, while 13% had an associated traumatic brain injury. Of the 284 patients who survived over 24 h and were not transferred from another institution, 65 (23%) underwent a neck exploration. The injury burden was significantly higher in this group as indicated by the higher median Injury Severity Score (17 vs 10, p < 0.01) and need for intensive care unit admission (75% vs 31%, p < 0.01). The overall mortality was 2%: 3.1% for neck explorations versus 1.6% for conservative management (adjusted p = 0.54). Neck exploration patients were more likely to remain longer in the hospital (median 13 vs 10 days, adjusted p = 0.03). Conclusion: Pharyngoesophageal injuries are rare following blunt trauma. Only a quarter require a neck exploration and this decision appears to be dictated by the injury burden. Selective non-operative management based on clinical status seems to be feasible and is not associated with increased mortality.

Publisher

SAGE Publications

Subject

Surgery

Cited by 5 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. A Case of Posterior Pharyngeal Wall Perforation After Blunt Neck Trauma;Journal of The Korean Society of Laryngology, Phoniatrics and Logopedics;2024-04-30

2. Esophageal Injuries and Esophageal Emergencies in Geriatric Patients;Acute Care Surgery in Geriatric Patients;2023

3. Update Halstraumata;HNO;2022-09-06

4. Diagnóstico, manejo y tratamiento de las lesiones cervicales traumáticas;Cirugía Española;2019-11

5. Blunt Pharyngoesophageal Injury: an Overview of a Rare Entity;Current Trauma Reports;2019-02-02

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