Pediatric oropharyngeal trauma: what is the role of CT scan?
OBJECTIVE
Pediatric oropharyngeal trauma (OPT) is a common injury in children with rare, but at times severe complications including carotid injury and dissection of air/micro-organisms into the deep tissues of the neck or chest. Cervical CT scan with contrast (CT angiography (CTA)) is nearly universally available and may enhance the evaluation of OPT patients by screening for these potentially devastating complications.


METHODS
Retrospective record review, systematic review of the literature.


METHODS
Twenty-three patients diagnosed with OPT from 1997 to 2003 at Boston Children's Hospital were identified by database review. Records were reviewed for site and mechanism of injury, use of diagnostic studies, management, and outcomes. Results were compared to previously published reports. The current literature was reviewed to assess the level of evidence pertaining to the evaluation of OPT patients with CT scan. An extrapolation was made to the general trauma literature to further evaluate the ability of CT angiography to detect carotid injury.


RESULTS
Demographics and mechanism of injury in the current series were unchanged from previous reports. CT demonstrated superior detection and localization of free air. Systematic review of OPT literature revealed data on the use of CT scan as evaluation tool were lacking. Extrapolations to the trauma literature strongly indicate helical CTA has high sensitivity and specificity in detecting carotid injury.


CONCLUSIONS
Pediatric oropharyngeal trauma is a common injury with rare, but severe complications. The routine use of CT scan with contrast may assist in the evaluation of these patients to detect injuries that could lead to severe complications. Collection of prospective data on the ability of CT scan to detect carotid injuries is needed but may not be feasible.
Brietzke
Scott E
SE
Boston Children's Hospital, Boston, MA, USA. SEBrietzke@msn.com
Jones
Dwight T
DT
D000293:Adolescent; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D009960:Oropharynx / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D003287:Contrast Media