The Journal of Laryngology and Otology September 1992, Vol. 106, pp. 813-816
Penetrating injuries to the oropharynx HIROKO KOSAKI,
M.D.,* NAOYA
NAKAMURA,
M.D.,**
YASUJI TORIYAMA,
M.D.,*** (Tokyo, Japan)
Abstract A review was made of 12 cases of penetrating injuries to the oropharynx seen at Musashino Red Cross Hospital during the period from 1984 to 1988, and their records were compared with those of past cases with similar injuries reported in a survey for the period between 1949 and 1959. Most of the patients were children under the age of four and were injured when they fell with a sharp-edged object in the mouth. Penetrating injuries to the oropharynx occasionally cause severe complications, including retropharyngeal abscess and mediastinitis. This type of injury should be called a 'pencil injury'.
(Table III). Three of the 12 patients had not only penetrating injuries in their mouths, but also developed complications including mediastinitis, mediastinal emphysema, retropharyngeal abscess and subcutaneous emphysema and were hospitalized as a result (Kikuchi et al., 1987). The other nine patients were treated in the outpatient clinic. All of the 12 patients were treated first with oral antibiotics. Three hospitalized patients were given additional antibiotics intravenously. One patient needed surgical drainage and continuous suction to the treat her abscess.
Introduction Accidental penetrating wounds to the oropharynx in infants who have fallen down with something sharp like a stick or a pen in their mouth are often seen in emergency departments. In these cases, the penetrating injury may be deep, causing serious life-threatening complications. (Caldwell, 1936; Shimizu, 1979; Shirali et al., 1988). Deep neck abscess, pneumoencephalocoele and internal carotid thrombosis have been reported as complications of penetrating injuries to the oropharynx in the literature (Kikuchi et al., 1987; Kosaki et al., 1989; Kosaki and Nakamura, 1990). The present authors have successfully treated a total of 12 penetrating injuries to the oropharynx in young children during the past five years. A clinical review is made with a retrospective analysis comparing these cases with similar injuries seen in our hospital during the period from 1949 to 1959.
Case reports Case 1. A one-year-old girl, experienced trauma to her left tonsil when she fell on the floor with a toothbrush in her mouth. She had had a similar trauma with a skewer six months previously, but at that time she had not developed any complications. A few hours after the toothbrush injury, she developed a fever and sore throat. We administered cephaclol, but she soon became unable to eat or drink due to the throat pain. Three days later she was hospitalized in the paediatric division of our hospital for dehydration and dyspnoea. Her neck was severely swollen at that time. On the second day of hospitalization, her breathing suddenly stopped, and she was immediately intubated. Her pharyngeal space was narrow. Subcutaneous emphysema of her neck and anterior chest wall appeared a few hours later. On X-ray examination, there was a huge lucent area in the neck and chest (Figs. 1 a & b). The width between the vertebral bodies and the posterior pharyngeal wall was wide, and thus we suspected a retropharyngeal emphysema or abscess. Computed tomography revealed that the airway was limited to the space ensured by the endotracheal tube (Fig. 2). We
Patients and injuries From 1984 to 1988, a total of 12 penetrating injuries to the oropharynx were seen at the Department of Otorhinolaryngology, Musashino Red Cross Hospital, Tokyo (Table I). The age of the patients ranged from 6 months to 6 years, with a higher incidence in the range of one to three years. There was no sex difference in terms of incidence. The penetrating agents were toothbrushes in four cases, chop-sticks in three, toys in two, and a pencil, a bamboo ruler, and afishbone in one case each (Table II). The accidents mostly occurred when the children tripped and fell with the sharp objects in their mouths. In eight cases, the patients experienced trauma on these occasions. The tonsil (on either side), the posterior pharyngeal wall, and the soft palate were most frequently injured
* Department of Otorhinolaryngology, University of Tokyo, Tokyo. ** Department of Otorhinolaryngology, Toshiba Central Hospital, Tokyo. *** Department of Otorhinolaryngology, Musashino Red Cross Hospital, Tokyo. Paper presented at the Sixth World Congress of Bronchoesophagology, Tokyo, Japan, October 15-18, 1989. Accepted for publication: 29 May 1992. 813
814
H. KOSAKI, N. NAKAMURA, Y. TOR1YAMA
TABLE I AGE AND SEX DISTRIBUTIONS IN THE 1984—1988 SERIES
Age (year) 0-1
2
3
4
5-9
Males Females
2 2
2 1
1 2
1 0
0 1
6 (patients) 6 (patients)
4
3
3
1
1
12 (patients)
Total
carried out surgical drainage and continuous suction, and administered a massive dose of antibiotics. Her condition improved, and she was discharged after 50 days of hospitalization. Case 2. A 2-year-old girl, fell down with a toothbrush in her mouth, injuring her right tonsil. Three to four hours after the accident, a huge subcutaneous emphysema appeared in her neck. Air was also revealed in the retropharyngeal space and mediastinum (Fig. 3). As we assumed that there was no abscess, we did not attempt surgical drainage, but administered antibiotics intravenously. Her condition improved, and she was discharged from the hospital after 10 days. Case 3. A 1-year-old girl, fell with a toy in her mouth and injured her posterior pharyngeal wall. As we saw an emphysema in her retropharyngeal space, she was hospitalized for eight days and treated with antibiotics before discharge. An earlier retrospective study was made of the penetrating injuries to the oropharynx treated in our department during the period from 1949 to 1959 (Tables IV and V) (Toriyama et al., 1960). It is obvious that the incidence of such injuries was similar to that from 1984 to 1988 in children under the age of four, with the ratio of males to females being 2:1. The penetrating agents included sticks, toothbrushes, bamboo flutes, bamboo rulers, chopsticks, pencils, etc. Although the exact causes of the accidents were unclear, most of the penetrating agents were sharppointed or sharp-edged. In that earlier retrospective study, no severe complications were recorded, although in six cases, the agent penetrated through the soft palate. This type of penetrating injury to the oropharynx occurred in similar situations in both time periods. Discussion Penetrating injuries to the oropharynx are presently attracting attention, particularly because they might cause carotid artery thrombosis (Biccerstaff, 1964; Pitner, 1966). Some characteristics of this type of injury are the following. TABLE II
(1) Most such patients are young children, especially under four years of age. (2) A patient usually falls with a sharp object in his/her mouth, which then penetrates the oropharynx. (3) Within 48 hours after the trauma, some patients show neurological symptoms such as hemiparesis, aphasia, coma etc. (4) Even when the injury does not reach the internal carotid artery directly, there is a possibility of thrombosis. Since young children often place sharp-edged objects in their mouths, such accidents easily occur. Although older children or adults may experience such trauma when they are brushing their teeth or using forks, spoons, or chopsticks, generally, the patients are young children (Kosaki et al., 1989; Kosaki and Nakamura, 1990). The term 'pencil injury' has been used for injuries causing internal carotid thrombosis (Pitner, 1966). However, the same term can be used for other types of penetrating injuries to the oropharynx in children, as they have similar features. Internal carotid thrombosis may be a severe complication of penetrating injuries to the oropharynx. The term 'pencil' seems to be adequate for indicating a penetrating injury, and all penetrating injuries to the oropharynx have the possibility of dangerous complications. In our patients, no case of internal carotid thrombosis was seen. Instead, we saw retropharyngeal emphysema and abscess, mediastinitis and mediastinal emphysema. In Table I, the ratio of males to females is 1:1, while in Table II, the ratio is 2:1. It has been reported that so-called pencil injuries occur with almost the same frequency in boys and girls, or slightly more frequently in males (Kosaki and Nakamura, 1990). In Japan, chopsticks have often been penetrating agents, perhaps because they are in use for eating everyday (Shimizu, 1979; Kosaki et al, 1989). For the same reason, forks are often the penetrating agents in other countries. Particularly, since chopsticks have a single sharp point, and a length of 20-30 cm, it has even been reported that they can reach the middle ear, retropharyngeal space, parapharyngeal space, or parotid glands in cases of injury and cause pneumoencephalos, internal carotid thrombosis etc (Kikuchi et al., 1987; Kosaki et al., 1989). The retropharyngeal space consists of two spaces: the ventral part is called the 'retropharyngeal space' in a narrow sense, and the dorsal part is called the 'danger space'. Since they are the third and fourth intra-fascial spaces from the anterior surface in the neck, respectively, they are often called 'space 3' and 'space 4' (Hollinshed, 1982). These two spaces are separated by the alar fascia. As this fascia adheres to the buccopharyngeal fascia at the lower neck, space 3, which is situated anterior to space 4, ends at
PENETRATING AGENTS AND THEIR INCIDENCE IN THE 1984—1988 SERIES
Agent Toothbrush Chopsticks Toy Fish bone Ruler Pencil Skewer
Males
Females
Total Location
2 1 0 1 1 1 0 6 (patients)
Patient 1 had two episodes.
TABLE III LOCATION OF INJURIES IN THE 1984-1988 SERIES
Soft palate PPW Tonsil Floor of mouth
Males
13* (patients)
Total
7* (patients)
13* (patients)
2 1 2 1 6 (patients)
7* (patients)
Females
PPW: posterior pharyngeal wall. * Patient 1 had two episodes.
815
PENETRATING INJURIES TO THE OROPHARYNX
FIG. l(a) A huge lucent zone was seen in the neck and the mediastinum of patient 1.
FIG. l(b) Because of the retropharyngeal abscess, the width between the vertebral bodies and posterior pharyngeal wall had widened in patient 1.
FIG. 2
FIG. 3
The airway was limited to the space insured by the endotracheal tube in patient 1.
Air had spread into the retropharyngeal, parapharyngeal and subcutaneous spaces in patient 2.
816
H. KOSAKI, N. NAKAMURA, Y. TORIYAMA
TABLE IV AGE AND SEX DISTRIBUTIONS IN THE 1 9 4 9 - 1 9 5 9 SERIES
Age (year) Males Females
0-1
2
3
4
5-9
10-
20-
30-
40-
Total
5 1
6 2
1 0
1 1
3 0
0 1
1 0
1 0
1 2
19 (patients) 7 (patients)
6
8
1
2
3
1
1
1
3
26 (patients)
Reprinted, with permission, from Toriyama et al.
the lower neck. If inflammation or emphysema is limited only to the space 3, it stays only in the neck. But once it spreads into the space 4, it can then affect the mediastinum. Usually inflammation or abscess develops along the fascia and does not pass through it. But if the fascia is penetrated in a surgical operation or trauma, inflammation or abscess can spread through the fascia and involve other intrafascial spaces. (Hollinshed, 1982; Simpson and Peters, 1988; Thompson et al., 1988). For this reason, penetrating injuries must be treated carefully. Acknowledgements We would like to extend our sincere appreciation to Professor Yasuya Nomura and Professor Hajime Hirose, Faculty of Medicine, University of Tokyo, for their valuable advice during the preparation of the manuscript. TABLE V PENETRATING AGENTS AND THEIR INCIDENCE IN THE 1 9 4 9 - 1 9 5 9 SERIES
Agent Bamboo flute Stick Toothbrush Spoon Pencil Cloth duster hundle Chopstick Ruler Wire Toy flagpole Knitting needle Metal rod Skewer Clasp of a purse Fish bone
Males
Females
4 1 3 1 2 1 1 1 1 1 1 1 0 1 0
0 3 1 1 0 0 0 0 0 0 0 0 1 0 1
19 (patients)
7 (patients)
Total 4 4 4 2 2 1 1 1 1 1 1 1 0 1 1 26 (patients)
Reprinted, with permission, from Toriyama et al.
Key words: Oropharynx; Wounds, penetrating.
References Biccerstaff, E. R. (1964) Aetiology of acute hemiplegia in childhood. British Medical Journal, 2: 82-87. Caldwell, J. A. (1936) Post-traumatic thrombosis of internal carotid artery. American Journal of Surgery, 32: 552-523. Hollinshed, W. F. (1982) Anatomy for Surgeons, 3rd edn., Vol. 1. Harper & Row, New York, p. 272-277. Kikuchi, T., Kobayashi, T, Hozawa, K., Kusakari, J., Takasaka, T. (1987) Penetrating deep injuries of the oropharynx by chopsticks—a report of two cases. Practical Otology, (Kyoto) 80: 777-782. (In Japanese). Kosaki, H., Hiratsuka, M., Nakamura, N., Syouji, M.,Toriyama, Y., Yosimura, E., Kaku, S. (1989) Three cases of children with retropharyngeal abscess, mediastinitis, and mediastinal emphysema, secondary to oropharyngeal injury. Journal of Japanese Bronchoesophargological Society, 40: 320-328. (In Japanese). Kosaki, H., Nakamura, N. (1990) Penetrating injury of oropharynx and retropharyngeal and mediastinal extension. In Recent advances in bronchoesophagology. (Inoue, T., Fukuda, H., eds.), Elsevier Science Publishers, Amsterdam, p. 509-510. Pitner, S. E. (1966) Carotid thrombosis due to internal trauma. NewEngland Journal of Medicine, 274: 764—767. Shimizu, M. (1979) Injuries to the soft tissues of the oral cavity and the face in children. Asian Medical Journal, 23: 531-534. Shirali, G. N., Savant, R. A., Uppal, P. K., Bhargava, K. B. (1988) Toothbrush: an unusual foreign body in ENT practice. Journal of Laryngology and Otology, 102: 1068-1069. Simpson, L. C , Peters, G. E. (1988) Post sternotomy infections presenting as deep neck abscess. Archives of Otolaryngology, 114: 909-912. Thompson, J. W., Cohen, S. R., Reddix, P. (1988) Retropharyngeal abscess in children: A retrospective and historical analysis. Laryngoscope, 98: 589-592. Toriyama, Y., Takeda, T, Saegusa, N. (1961) Statistical observation of the patients in ENT department of Musashino Red Cross Hospital in the past 10 years. Japanese Journal of Otology, Rhinology and Laryngology, 64: 1669-1683. (In Japanese). Address for correspondence: Hiroko Kosaki, M.D., Department of Otorhinolaryngology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113, Japan. Fax: (3) 3814-9486.
Penetrating injuries to the oropharynx HIROKO KOSAKI,
M.D.,* NAOYA
NAKAMURA,
M.D.,**
YASUJI TORIYAMA,
M.D.,*** (Tokyo, Japan)
Abstract A review was made of 12 cases of penetrating injuries to the oropharynx seen at Musashino Red Cross Hospital during the period from 1984 to 1988, and their records were compared with those of past cases with similar injuries reported in a survey for the period between 1949 and 1959. Most of the patients were children under the age of four and were injured when they fell with a sharp-edged object in the mouth. Penetrating injuries to the oropharynx occasionally cause severe complications, including retropharyngeal abscess and mediastinitis. This type of injury should be called a 'pencil injury'.
(Table III). Three of the 12 patients had not only penetrating injuries in their mouths, but also developed complications including mediastinitis, mediastinal emphysema, retropharyngeal abscess and subcutaneous emphysema and were hospitalized as a result (Kikuchi et al., 1987). The other nine patients were treated in the outpatient clinic. All of the 12 patients were treated first with oral antibiotics. Three hospitalized patients were given additional antibiotics intravenously. One patient needed surgical drainage and continuous suction to the treat her abscess.
Introduction Accidental penetrating wounds to the oropharynx in infants who have fallen down with something sharp like a stick or a pen in their mouth are often seen in emergency departments. In these cases, the penetrating injury may be deep, causing serious life-threatening complications. (Caldwell, 1936; Shimizu, 1979; Shirali et al., 1988). Deep neck abscess, pneumoencephalocoele and internal carotid thrombosis have been reported as complications of penetrating injuries to the oropharynx in the literature (Kikuchi et al., 1987; Kosaki et al., 1989; Kosaki and Nakamura, 1990). The present authors have successfully treated a total of 12 penetrating injuries to the oropharynx in young children during the past five years. A clinical review is made with a retrospective analysis comparing these cases with similar injuries seen in our hospital during the period from 1949 to 1959.
Case reports Case 1. A one-year-old girl, experienced trauma to her left tonsil when she fell on the floor with a toothbrush in her mouth. She had had a similar trauma with a skewer six months previously, but at that time she had not developed any complications. A few hours after the toothbrush injury, she developed a fever and sore throat. We administered cephaclol, but she soon became unable to eat or drink due to the throat pain. Three days later she was hospitalized in the paediatric division of our hospital for dehydration and dyspnoea. Her neck was severely swollen at that time. On the second day of hospitalization, her breathing suddenly stopped, and she was immediately intubated. Her pharyngeal space was narrow. Subcutaneous emphysema of her neck and anterior chest wall appeared a few hours later. On X-ray examination, there was a huge lucent area in the neck and chest (Figs. 1 a & b). The width between the vertebral bodies and the posterior pharyngeal wall was wide, and thus we suspected a retropharyngeal emphysema or abscess. Computed tomography revealed that the airway was limited to the space ensured by the endotracheal tube (Fig. 2). We
Patients and injuries From 1984 to 1988, a total of 12 penetrating injuries to the oropharynx were seen at the Department of Otorhinolaryngology, Musashino Red Cross Hospital, Tokyo (Table I). The age of the patients ranged from 6 months to 6 years, with a higher incidence in the range of one to three years. There was no sex difference in terms of incidence. The penetrating agents were toothbrushes in four cases, chop-sticks in three, toys in two, and a pencil, a bamboo ruler, and afishbone in one case each (Table II). The accidents mostly occurred when the children tripped and fell with the sharp objects in their mouths. In eight cases, the patients experienced trauma on these occasions. The tonsil (on either side), the posterior pharyngeal wall, and the soft palate were most frequently injured
* Department of Otorhinolaryngology, University of Tokyo, Tokyo. ** Department of Otorhinolaryngology, Toshiba Central Hospital, Tokyo. *** Department of Otorhinolaryngology, Musashino Red Cross Hospital, Tokyo. Paper presented at the Sixth World Congress of Bronchoesophagology, Tokyo, Japan, October 15-18, 1989. Accepted for publication: 29 May 1992. 813
814
H. KOSAKI, N. NAKAMURA, Y. TOR1YAMA
TABLE I AGE AND SEX DISTRIBUTIONS IN THE 1984—1988 SERIES
Age (year) 0-1
2
3
4
5-9
Males Females
2 2
2 1
1 2
1 0
0 1
6 (patients) 6 (patients)
4
3
3
1
1
12 (patients)
Total
carried out surgical drainage and continuous suction, and administered a massive dose of antibiotics. Her condition improved, and she was discharged after 50 days of hospitalization. Case 2. A 2-year-old girl, fell down with a toothbrush in her mouth, injuring her right tonsil. Three to four hours after the accident, a huge subcutaneous emphysema appeared in her neck. Air was also revealed in the retropharyngeal space and mediastinum (Fig. 3). As we assumed that there was no abscess, we did not attempt surgical drainage, but administered antibiotics intravenously. Her condition improved, and she was discharged from the hospital after 10 days. Case 3. A 1-year-old girl, fell with a toy in her mouth and injured her posterior pharyngeal wall. As we saw an emphysema in her retropharyngeal space, she was hospitalized for eight days and treated with antibiotics before discharge. An earlier retrospective study was made of the penetrating injuries to the oropharynx treated in our department during the period from 1949 to 1959 (Tables IV and V) (Toriyama et al., 1960). It is obvious that the incidence of such injuries was similar to that from 1984 to 1988 in children under the age of four, with the ratio of males to females being 2:1. The penetrating agents included sticks, toothbrushes, bamboo flutes, bamboo rulers, chopsticks, pencils, etc. Although the exact causes of the accidents were unclear, most of the penetrating agents were sharppointed or sharp-edged. In that earlier retrospective study, no severe complications were recorded, although in six cases, the agent penetrated through the soft palate. This type of penetrating injury to the oropharynx occurred in similar situations in both time periods. Discussion Penetrating injuries to the oropharynx are presently attracting attention, particularly because they might cause carotid artery thrombosis (Biccerstaff, 1964; Pitner, 1966). Some characteristics of this type of injury are the following. TABLE II
(1) Most such patients are young children, especially under four years of age. (2) A patient usually falls with a sharp object in his/her mouth, which then penetrates the oropharynx. (3) Within 48 hours after the trauma, some patients show neurological symptoms such as hemiparesis, aphasia, coma etc. (4) Even when the injury does not reach the internal carotid artery directly, there is a possibility of thrombosis. Since young children often place sharp-edged objects in their mouths, such accidents easily occur. Although older children or adults may experience such trauma when they are brushing their teeth or using forks, spoons, or chopsticks, generally, the patients are young children (Kosaki et al., 1989; Kosaki and Nakamura, 1990). The term 'pencil injury' has been used for injuries causing internal carotid thrombosis (Pitner, 1966). However, the same term can be used for other types of penetrating injuries to the oropharynx in children, as they have similar features. Internal carotid thrombosis may be a severe complication of penetrating injuries to the oropharynx. The term 'pencil' seems to be adequate for indicating a penetrating injury, and all penetrating injuries to the oropharynx have the possibility of dangerous complications. In our patients, no case of internal carotid thrombosis was seen. Instead, we saw retropharyngeal emphysema and abscess, mediastinitis and mediastinal emphysema. In Table I, the ratio of males to females is 1:1, while in Table II, the ratio is 2:1. It has been reported that so-called pencil injuries occur with almost the same frequency in boys and girls, or slightly more frequently in males (Kosaki and Nakamura, 1990). In Japan, chopsticks have often been penetrating agents, perhaps because they are in use for eating everyday (Shimizu, 1979; Kosaki et al, 1989). For the same reason, forks are often the penetrating agents in other countries. Particularly, since chopsticks have a single sharp point, and a length of 20-30 cm, it has even been reported that they can reach the middle ear, retropharyngeal space, parapharyngeal space, or parotid glands in cases of injury and cause pneumoencephalos, internal carotid thrombosis etc (Kikuchi et al., 1987; Kosaki et al., 1989). The retropharyngeal space consists of two spaces: the ventral part is called the 'retropharyngeal space' in a narrow sense, and the dorsal part is called the 'danger space'. Since they are the third and fourth intra-fascial spaces from the anterior surface in the neck, respectively, they are often called 'space 3' and 'space 4' (Hollinshed, 1982). These two spaces are separated by the alar fascia. As this fascia adheres to the buccopharyngeal fascia at the lower neck, space 3, which is situated anterior to space 4, ends at
PENETRATING AGENTS AND THEIR INCIDENCE IN THE 1984—1988 SERIES
Agent Toothbrush Chopsticks Toy Fish bone Ruler Pencil Skewer
Males
Females
Total Location
2 1 0 1 1 1 0 6 (patients)
Patient 1 had two episodes.
TABLE III LOCATION OF INJURIES IN THE 1984-1988 SERIES
Soft palate PPW Tonsil Floor of mouth
Males
13* (patients)
Total
7* (patients)
13* (patients)
2 1 2 1 6 (patients)
7* (patients)
Females
PPW: posterior pharyngeal wall. * Patient 1 had two episodes.
815
PENETRATING INJURIES TO THE OROPHARYNX
FIG. l(a) A huge lucent zone was seen in the neck and the mediastinum of patient 1.
FIG. l(b) Because of the retropharyngeal abscess, the width between the vertebral bodies and posterior pharyngeal wall had widened in patient 1.
FIG. 2
FIG. 3
The airway was limited to the space insured by the endotracheal tube in patient 1.
Air had spread into the retropharyngeal, parapharyngeal and subcutaneous spaces in patient 2.
816
H. KOSAKI, N. NAKAMURA, Y. TORIYAMA
TABLE IV AGE AND SEX DISTRIBUTIONS IN THE 1 9 4 9 - 1 9 5 9 SERIES
Age (year) Males Females
0-1
2
3
4
5-9
10-
20-
30-
40-
Total
5 1
6 2
1 0
1 1
3 0
0 1
1 0
1 0
1 2
19 (patients) 7 (patients)
6
8
1
2
3
1
1
1
3
26 (patients)
Reprinted, with permission, from Toriyama et al.
the lower neck. If inflammation or emphysema is limited only to the space 3, it stays only in the neck. But once it spreads into the space 4, it can then affect the mediastinum. Usually inflammation or abscess develops along the fascia and does not pass through it. But if the fascia is penetrated in a surgical operation or trauma, inflammation or abscess can spread through the fascia and involve other intrafascial spaces. (Hollinshed, 1982; Simpson and Peters, 1988; Thompson et al., 1988). For this reason, penetrating injuries must be treated carefully. Acknowledgements We would like to extend our sincere appreciation to Professor Yasuya Nomura and Professor Hajime Hirose, Faculty of Medicine, University of Tokyo, for their valuable advice during the preparation of the manuscript. TABLE V PENETRATING AGENTS AND THEIR INCIDENCE IN THE 1 9 4 9 - 1 9 5 9 SERIES
Agent Bamboo flute Stick Toothbrush Spoon Pencil Cloth duster hundle Chopstick Ruler Wire Toy flagpole Knitting needle Metal rod Skewer Clasp of a purse Fish bone
Males
Females
4 1 3 1 2 1 1 1 1 1 1 1 0 1 0
0 3 1 1 0 0 0 0 0 0 0 0 1 0 1
19 (patients)
7 (patients)
Total 4 4 4 2 2 1 1 1 1 1 1 1 0 1 1 26 (patients)
Reprinted, with permission, from Toriyama et al.
Key words: Oropharynx; Wounds, penetrating.
References Biccerstaff, E. R. (1964) Aetiology of acute hemiplegia in childhood. British Medical Journal, 2: 82-87. Caldwell, J. A. (1936) Post-traumatic thrombosis of internal carotid artery. American Journal of Surgery, 32: 552-523. Hollinshed, W. F. (1982) Anatomy for Surgeons, 3rd edn., Vol. 1. Harper & Row, New York, p. 272-277. Kikuchi, T., Kobayashi, T, Hozawa, K., Kusakari, J., Takasaka, T. (1987) Penetrating deep injuries of the oropharynx by chopsticks—a report of two cases. Practical Otology, (Kyoto) 80: 777-782. (In Japanese). Kosaki, H., Hiratsuka, M., Nakamura, N., Syouji, M.,Toriyama, Y., Yosimura, E., Kaku, S. (1989) Three cases of children with retropharyngeal abscess, mediastinitis, and mediastinal emphysema, secondary to oropharyngeal injury. Journal of Japanese Bronchoesophargological Society, 40: 320-328. (In Japanese). Kosaki, H., Nakamura, N. (1990) Penetrating injury of oropharynx and retropharyngeal and mediastinal extension. In Recent advances in bronchoesophagology. (Inoue, T., Fukuda, H., eds.), Elsevier Science Publishers, Amsterdam, p. 509-510. Pitner, S. E. (1966) Carotid thrombosis due to internal trauma. NewEngland Journal of Medicine, 274: 764—767. Shimizu, M. (1979) Injuries to the soft tissues of the oral cavity and the face in children. Asian Medical Journal, 23: 531-534. Shirali, G. N., Savant, R. A., Uppal, P. K., Bhargava, K. B. (1988) Toothbrush: an unusual foreign body in ENT practice. Journal of Laryngology and Otology, 102: 1068-1069. Simpson, L. C , Peters, G. E. (1988) Post sternotomy infections presenting as deep neck abscess. Archives of Otolaryngology, 114: 909-912. Thompson, J. W., Cohen, S. R., Reddix, P. (1988) Retropharyngeal abscess in children: A retrospective and historical analysis. Laryngoscope, 98: 589-592. Toriyama, Y., Takeda, T, Saegusa, N. (1961) Statistical observation of the patients in ENT department of Musashino Red Cross Hospital in the past 10 years. Japanese Journal of Otology, Rhinology and Laryngology, 64: 1669-1683. (In Japanese). Address for correspondence: Hiroko Kosaki, M.D., Department of Otorhinolaryngology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113, Japan. Fax: (3) 3814-9486.
