MANAGEMENT OF TRAUMATIC HYPOPHARYNGEAL INJURIES

Violation of the hypopharynx by external penetrating trauma is an unco mmon occurrence that may lead to life-threatening infectious complicat ions if not recognized promptly and treated appropriately. A retrospec tive review of 48 such injuries seen during a 10-year period showed th at flexible fiberoptic endoscopic examination is the best screening to ol for recognition of a possible hypopharyngeal mucosal violation. Dir ect laryngopharyngoscopy is the best method of definitively diagnosing the injury. Size of the visualized mucosal violation alone is not suf ficient information on which to base the decision for medical manageme nt versus surgical intervention (i.e., immediate exploration and drain age). Rather, the size, exact site of injury, and mechanism of the inj ury must be considered to have equal importance. Associated vertebral body fractures may negatively influence acute outcome if diagnosis and treatment of the hypopharyngeal injury are delayed by the cervical sp ine injury.