Resident Manual of Trauma to the Face, Head and Neck

c. Evaluation of Endoscopy i. Endoscopic Stages of Esophageal Injuries Table 10.3 presents the endoscopic stages of esophageal injuries, along with information about treatment and outcome.

Table 10.3. Endoscopic Stages of Esophageal Burns Grade of Injury Effect of Injury

Injury Treatment and Outcome

Normal

No erythema

No healing time. Consistently heals uneventfully.

First degree

Mucosal erythema

Second degree Mucosal erythema Noncircumferential exudate

Occasionally forms strictures.

Most form strictures.

Third degree

Mucosal erythema Circumferential exudate.

Carries the additional risk of sepsis and mediastinitis. Small perforations may be treated conservatively. Larger perforations with surrounding necrosis may require resection with reanastomosis.

Fourth degree

Mucosal erythema Circumferential exudate Esophageal wall perforation

Source: Flint et al., Figure 211-2.

ii. Tracheoscopy Tracheoscopy should be included to examine the posterior tracheal wall for all third- and fourth-degree injuries. iii. Abortion of Endoscopic Evaluation Endoscopic evaluation should be aborted when there is no definable lumen. iv. Type of Esophagoscope Rigid and flexible esophagoscopes may both be used. However, a flexible esophagoscope is needed to adequately visualize the stomach.

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