OCCULT PHARYNGEAL PERFORATION SECONDARY TO PENCIL INJURY

Palatopharyngeal injuries due to impaction of rigid objects held in th e mouth are common. Most are essentially innocuous injuries requiring no specific treatment. However, there is the potential for perforation of the pharyngeal wall with the subsequent development of serious inf ection such as retropharyngeal abscess or mediastinitis. This possibil ity is more likely to be suspected in the presence of a visible lacera tion or puncture wound at the site of impact in the mouth or pharynx. We report three cases in which occult pharyngeal perforation occurred without any clinical signs of breech of the pharyngeal wall. In all ca ses a lateral soft tissue neck X-ray was diagnostic of perforation, sh owing the presence of retropharyngeal air. We, therefore, advocate the routine performance of soft tissue neck X-rays in all patients who pr esent with a history of falling on a rigid object held in the mouth.