Resident Manual of Trauma to the Face, Head and Neck

H. Complications 1. Esophageal Perforation

Esophageal perforation may lead to mediastinitis, sepsis, and ultimately death. Patients with esophageal perforations should be monitored closely and treated as discussed previously. 2. Esophageal Strictures Esophageal strictures most commonly occur at the level of the crico- pharyngeus, aortic arch, or lower esophageal sphincter. Strictures from caustic ingestion tend to be longer and tighter than benign strictures and may be refractory to and have a higher rate of complications with dilation. 3. Esophageal Carcinoma Esophageal carcinoma may develop after caustic ingestion. One in seven patients may develop malignancy, leading some physicians to advocate for regular esophageal surveillance, although the latent period for development may be as long as 50 years. Nodularity or ulceration in the region of a previously smooth stricture suggests malignant transformation. IV. Conclusion Foreign body aspiration or ingestion and caustic ingestion are serious, potentially life-threatening emergencies. In the course of trauma, foreign bodies, such as chewing gum, teeth, dentures, and other detritus of impact, can be ingested or aspirated, complicating the evaluation and treatment of traumatic injuries. Any difficulties with airway and breath- ing after traumatic events should raise the specter of possible foreign bodies in the aerodigestive tract, in addition to the other possible etiologies. Caustic ingestions, while not as common as foreign body aspiration/ingestion, can also occur during traumatic episodes, particu- larly burns and by-products of combustion engines, batteries, and industrial equipment. The most dangerous conditions exist when these emergencies are seen in pediatric patients, as their airways are small and susceptible, and their functional reserves are quite restricted. The otolaryngology–head and neck surgery resident must be highly suspicious for these injuries and understand the evaluative and therapeutic procedures to rescue the patients. This includes knowledge about the historical information, findings on physical examination, appropriate use of imaging studies, and the proper selection of endoscopic equipment and technology to clear the aerodigestive tract. This chapter provides the fundamental knowledge to care for patients with foreign bodies and caustic ingestion.

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