Pharyngeal perforation is an uncommon injury in children. Most reporte
d cases to date have been secondary to instrumentation or penetrating
wounds. Laceration to the pharyngeal wall may introduce air, secretion
s and bacteria into the parapharyngeal space and mediastinum and conse
quently has potentially life-threatening sequelae. The management of t
hese injuries is controversial. We present a series of four children w
ho suffered pharyngeal trauma, accidentally and otherwise, and discuss
their management. We recommend a high index of suspicion of pharyngea
l injury in all cases of oropharyngeal trauma and overnight admission
to hospital for observation until an accurate diagnosis has been estab
lished. Nonaccidental injury of the child must be seriously considered
in all cases.