Citation

Nyberg SM, Vasquez DG, Brown EM, Ntelekos J, Stanley MR, Williams MA. Kans. J. Med. 2021; 14: 231-233.

Copyright

(Copyright © 2021, University of Kansas Medical Center)

DOI

10.17161/kjm.vol1415290

PMID

34540139

Abstract

Hypopharyngeal perforation is a rare but potentially serious injury, typically results from instrumentation or external penetrating trauma. Perforation following blunt trauma is even more rare. Here we describe an unusual case of a hypopharyngeal perforation believed to have been caused by a dislodged chin strap of a football helmet. Perforations are most likely to occur at the hypopharyngeal-esophageal junction. Common symptoms that should prompt suspicion of hypopharyngeal injury include: subcutaneous emphysema, chest or neck pain, odynophagia, dysphagia, dysphonia, and hemoptysis. There is no consensus regarding the best diagnostic study for a suspected hypopharyngeal perforation, but available literature suggests some combination of plain radiographs, computed tomography scans, fluoroscopy, and nasopharyngolaryngoscopy in evaluating patients for this injury. The absence of management guidelines for a pharyngoesophageal injury, particularly for optimal operative management, is very likely a reflection of the infrequent incidence of these injuries. Recently, there has been a trend toward nonoperative treatment which includes broad spectrum antibiotics, nil per os status, parenteral nutrition, and follow up studies. The unique mechanism of injury seen in this case demonstrates the need for high index of suspicion when assessing a patient with pertinent symptoms. Hypopharyngeal perforations can be a source of serious morbidity and even cause mortality if not diagnosed and treated expeditiously.

Language: en

Keywords

blunt injuries; esophageal perforation; hypopharynx; neck injuries