Pharyngeal injuries
Pharyngeal injuries represent various types of damage to this vital organ, which are caused by aggressive external influences both outside and inside the pharynx. The cause may be not only a wound or a blow, but also a thermal or chemical burn. As a rule, a person receives external injuries by exposure to a traumatic factor through the neck tissue, and internal injuries due to its penetration through the nose or mouth into the pharynx.
The content of the article:
Classification of pharyngeal injuries
Causes of pharyngeal injuries
Symptoms of pharyngeal injury
Diagnosis of pharyngeal injuries
Treatment of pharyngeal injuries
Pharyngeal injuries
It is worth noting that the pharynx is associated with large arteries, as a result of which its injuries have serious consequences, up to a fatal outcome. If the main vessel is touched due to a wound in the pharynx, the bleeding will be intense and rapid, which makes it quite difficult to save the victim.
In addition, the pharynx borders on important nerve trunks, damage to which will cause disruption of the connection of a number of organs with the central nervous system. We must not forget that the pharynx performs two important functions in the human body — respiratory and esophageal, so its injuries are extremely dangerous.
Classification of pharyngeal injuries
The largest division of pharyngeal injuries — at the place of occurrence — into external and internal. In addition, they can be differentiated according to the situation of damage:
production;
domestic;
wartime.
Also , pharyngeal injuries are divided into groups according to the nature of the damage:
stab wounds;
blunt force trauma;
gunshot wounds;
ingress of a foreign body;
thermal burns;
chemical burns.
At the same time, the first three types usually relate to external injuries, and the second three — to internal ones.
Another important classification is according to the anatomical principle (in other words, according to the areas that were affected):
Isolated. In this case, the wound falls on the nasopharynx, oropharynx or larynx and does not affect other areas.
Matching. Here, when one of the sites is injured, the surrounding anatomical formations may also suffer. At the same time, each site is characterized by its own nearby zones.
Pharynx:
maxillofacial region;
skull;
torso.
Nasopharynx:
internal parts of the nose;
auditory tube;
the base of the skull;
neurovascular bundle;
upper cervical vertebrae.
Oropharynx:
oral cavity;
neurovascular bundle of the neck;
cervical vertebrae.
Hypopharynx:
epiglottis;
the root of the language;
neurovascular bundle;
lower cervical vertebrae;
arytenoid cartilages.
Combined. It is assumed that the two above-mentioned types of wounds are combined. Most often, combined damage to the pharynx is supplemented by a chemical or thermal burn.
Causes of pharyngeal injuries
As already mentioned, pharyngeal injuries can be classified according to the situations in which they are received. Let’s look at these situations in more detail.
External injuries are usually caused by mechanical action on the neck or directly on the pharynx. These can be:
fracture of the cervical spine;
subluxation of the hyoid bone;
pharyngeal contusion;
compression of the pharynx;
rupture of the walls of the pharynx;
penetrating wounds of various types (bullet, fragmentation, stab wounds).
With internal injuries, a certain factor penetrates into the pharynx and has a mechanical, chemical or thermal effect.
Mechanical effects have:
poorly chewed food;
bones from fish or meat;
seeds of berries or fruits;
accidentally swallowed household items (this often happens to children).
A foreign body can cause a slight wound (an abrasion or scratch), and pierce the wall of the pharynx.
Thermal burns are less common than others, since the impact on the lips and mouth usually ends with spitting out hot water or food, and it does not reach the throat. Injuries of this kind are more often caused by inhaling hot steam.
If internal injuries of the pharynx are often accidental, then external (with the exception of an unsuccessful fall and an accompanying blow) are usually associated with conflicts reaching the point of attempted murder, as well as suicidal actions. At the same time, the most dangerous among them are damage to the side walls of the pharynx, located close to large vessels.
It is noteworthy that when trying to cut the throat, the larynx and trachea are more likely to be injured than the carotid artery. If a person throws his head back at the moment of injury, the most important vessel is hidden behind the muscles. You can also damage the larynx by injuring below the adam’s apple.
Symptoms of pharyngeal injury
The main features include:
respiratory distress;
violation of holoseducation;
swelling in the larynx;
bubbling blood in the wound canal, detected on exhalation with the mouth closed;
bleeding from the nose or mouth (in case of mechanical injury).
If the hyoid bone or the muscles associated with it are affected, then the tongue may sink, as a result of which a respiratory disorder develops. In addition, the formation of mediastinal emphysema with a narrow wound channel is possible.
With the defeat of nerve trunks with injuries of the pharynx, such disorders may occur as:
problems with articulation;
athonia (loss of voice with preservation of a whisper);
aphagia (inability to swallow food);
apnea (short-term respiratory arrest).
With thermal or chemical burns of the pharynx , the following symptoms occur:
unbearable pain;
increased blood filling of nearby vessels;
the appearance of a necrotic plaque (its color depends on what the throat was burned with).
We must not forget that chemical burns are accompanied by a general intoxication of the body, which will also manifest itself in its own way, depending on the affected substance.
Diagnosis of pharyngeal injuries
The research methods depend on the nature of the injury. With internal injuries, you should contact an otolaryngologist. To assess the condition of the pharynx , he can perform the following procedures:
laryngoscopy;
pharyngoscopy;
rhinoscopy;
stroboscopy (assessment of the condition of the vocal cords);
electroglottography (assessment of laryngeal mobility);
phonetography (acoustic analysis of the voice).
In addition, the diagnosis may include backfilling from the pharynx, which will clarify whether bacteria have entered the body through the damaged area, whether there is a development of infection.
If the pharyngeal injury is external, then you should contact a traumatologist. Diagnostics will include the following activities:
visual examination of the wound;
assessment of the state of the wound canal;
differentiation of penetrating or non-penetrating wounds;
assessment of the severity of a person’s condition.
At the same time, if the condition turns out to be severe, there may not be time for diagnosis as such. In this case, the above actions are performed directly during the operation.
If the condition of the victim is satisfactory, but the doctor suspects more serious consequences of the wound than are visually detected, he prescribes the following types of studies:
Ultrasound of the soft tissues of the neck;
x-ray of the pharynx;
computer or magnetic resonance imaging of the pharynx;
tomography of the skull, paranasal sinuses or spine.
Based on the results of the diagnosis, the doctor must determine which method of treatment will save the patient’s life and prevent serious consequences.
Treatment of pharyngeal injuries
In the first minutes after receiving a throat injury, the victim needs first aid. It consists mainly in restoring or maintaining the normal passage of air into the respiratory tract, as well as stopping bleeding, if any.
If there are signs of asphyxia, it is necessary to perform a tracheotomy — dissection of the tracheal wall for insertion into the formed lumen of the tube, which will provide air intake. Light bleeding can be stopped by pressing the carotid artery with your finger. In more serious cases, a pressure bandage is required.
If the esophagus is injured, the patient requires urgent surgical care, during which dissection and tamponade of the wound are performed. Also, surgery may be necessary in case of secondary airway obstruction at the larynx level.
After the operation, normal nutrition is not possible for some time. A gastrostomy or probe is used to feed such patients.
With thermal burns, swallowing is not prohibited at all, but the victim can only eat liquid and cold food that does not irritate the pharynx. Furacilin or potassium permanganate in the form of rinsing solutions are mainly used for treatment. In addition, the mucosa can be lubricated with a five percent solution of potassium permanganate.
Rinsing is also prescribed for the treatment of chemical burns. To do this , use:
sodium bicarbonate solution;
aqueous suspension of magnesium oxide;
vinegar;
water with lemon juice;
egg whites diluted in boiled water;
milk.
Although funds for the treatment of throat burns seem to be quite affordable, such victims should certainly be hospitalized. This is due to the risk of laryngeal edema, which entails the development of asphyxia.
