MANAGEMENT OF THE CAROTID-ARTERY FOLLOWING PENETRATING INJURIES OF THE SOFT PALATE

Penetrating injuries of the soft palate are not uncommon in the pediat ric population. The majority are minor, requiring only conservative tr eatment. Despite the close proximity of the carotid artery to lateral soft palate and tonsillar fossa, the incidence of carotid injury is lo w. When carotid injury does occur, it is usually secondary to blunt tr auma to the carotid with a resultant thrombosis. A concomitant neurolo gic deterioration often follows occurring from 3 h to 3 days after the initial injury (Hengerer et al. (1984). Laryngoscope 94, 1571-1575). The potential neurologic sequelae of such an injury make these seeming ly innocuous wounds a diagnostic and management dilemma for the clinic ian. We present an unusual case of an internal carotid artery pseudoan eurysm in a neurologically intact child following soft palate impaleme nt. We review the diagnostic evaluation including angiography and magn etic resonance angiography, the surgical approach, and postoperative i ssues including anticoagulation. The literature is reviewed and a disc ussion regarding the approach to penetrating injuries of the soft pala te is presented. (C) 1997 Elsevier Science Ireland Ltd.