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Jimenez-Ruiz F, Van Beck J, Jakubowski L, Kim T. Airway Management in Complete Oral Cavity Foreign Body Obstruction: A Case Report. A A Pract 2021; 15:e01379. [PMID: 33464782 DOI: 10.1213/xaa.0000000000001379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Foreign body (FB) injuries of the airway and of the digestive tract are common in pediatric patients. Available literature cites small blunt objects as a common FB leading to FB aspiration or ingestion. Complete oral cavity obstruction by a FB, however, is a rare and potentially life-threatening scenario. Airway management can be particularly challenging when access to the oral cavity is severely restricted. We present the anesthetic management of a child with complete oral cavity obstruction by a large fishing lure.
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Affiliation(s)
| | - Jenna Van Beck
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Luke Jakubowski
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.,Pediatric Otolaryngology and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota
| | - Tae Kim
- From the Department of Anesthesiology and
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Kondo K, Kikuchi M, Nasu D, Kaneko T, Horie N. Fork injuries with the tines inserted bilaterally between the mandibular interdental spaces. PEDIATRIC DENTAL JOURNAL 2019. [DOI: 10.1016/j.pdj.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Impalement injuries transfix a victim in an inescapable or helpless position. A study was undertaken at Forensic Science SA from 2002 to 2016 of all impalement deaths. There were six vehicle accidents (M:F=5:1; age 14-67 years, average age 38.5 years) involving impalements with a tree branch ( n=2; groin and chest), a metal pipe ( n=2; leg and head), a metal bridge railing (groin) and a metal fence post (chest). Two cases (both males, aged 47 and 18 years) had slipped on fences/gates, with impalements of the ankle and groin. A case of suicide (male, aged 80 years) was impaled through the head on a bolt fixed to the floor. A homicide case (male, aged 27 years) involved impalement through the chest by a spear from a spear gun. In certain cases (e.g. with anogenital injuries), differentiating accidental from inflicted impalement injuries may be difficult. In equivocal cases, adequate scene evaluations with photographic documentation are required prior to autopsy, ideally with the object available for examination.
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Affiliation(s)
- Roger W Byard
- 1 Forensic Science SA, Australia
- 2 School of Medicine, The University of Adelaide, Australia
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Umibe A, Omura K, Hachisu T, Anazawa U, Tanaka Y. Life-threatening injury caused by complete impalement of a toothbrush: Case report. Dent Traumatol 2017; 33:317-320. [DOI: 10.1111/edt.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Akiko Umibe
- Department of Otorhinolaryngology; Dokkyo Medical University Koshigaya Hospital; Saitama Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology; Dokkyo Medical University Koshigaya Hospital; Saitama Japan
| | - Takuya Hachisu
- Department of Otorhinolaryngology; Dokkyo Medical University Koshigaya Hospital; Saitama Japan
| | - Utaro Anazawa
- Department of Otorhinolaryngology; Dokkyo Medical University Koshigaya Hospital; Saitama Japan
| | - Yasuhiro Tanaka
- Department of Otorhinolaryngology; Dokkyo Medical University Koshigaya Hospital; Saitama Japan
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Uchino H, Kuriyama A, Kimura K, Ikegami T, Fukuoka T. Accidental oropharyngeal impalement injury in children: A report of two cases. J Emerg Trauma Shock 2015; 8:115-8. [PMID: 25949044 PMCID: PMC4411573 DOI: 10.4103/0974-2700.145403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/28/2014] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Impalement injuries in children may be deeper and more complicated than anticipated. We experienced two cases of accidental impalement injuries, one was through the oral cavity and the other was to the neck. We review these cases and the management of these types of injuries. CASE SERIES In case 1, a 20-month-old girl fell from the table with a toothbrush in her mouth. She was conscious, without any apparent neurologic or vascular injuries. Examination revealed a 2 mm laceration with a small hematoma in the right posterior pharyngeal wall. Contrast-enhanced computed tomography (CECT) revealed an air tract penetrating between the mandibular ramus and cervical vertebrae, passing by the carotid sheath, and reaching under the skin of the right posterior neck. Surgical emphysema was extended from the pharynx to the mediastinum. In case 2, a 3-year-old girl fell while holding a pencil. Physical examination revealed a 5 mm laceration in front of her right ear lobe accompanied by a small hematoma. Her facial movement was asymmetric, and she could not close her right eye. CECT showed swelling of the right parotid gland with heterogeneous enhancement and free air just in front of the right carotid sheath, which suggested the object penetrated through the parotid gland. A diagnosis of peripheral facial nerve injury was made. Physicians need to be aware of the potentially life-threatening complications of impalement injuries in children, as well as the specific complications related to proximity to specific anatomic structures.
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Affiliation(s)
- Hayaki Uchino
- Department of Emergency Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Akira Kuriyama
- Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Kenji Kimura
- Department of Medical Research and Education, Kurashiki Central Hospital, Okayama, Japan
| | - Tetsunori Ikegami
- Department of Emergency Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Toshio Fukuoka
- Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan
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Abstract
AIM To systemically collect and summarize the literature on case reports concerning adverse events associated with the oral use of a toothbrush. MATERIALS AND METHODS Two electronic databases were searched for articles published up to October 2013 to identify appropriate studies using focused search terms and 'case reports' as a filter. Results. A comprehensive search identified 419 unique titles and abstracts. Ninety-four studies met the eligibility criteria. In total, 118 subjects (age range = 1-60 years) presented adverse events related to the oral use of a toothbrush. Events could be summarized in five categories, of which ingestion was the most reported problem among the individuals (50 cases). This was followed by impaction of a toothbrush (27 cases). Reports more frequently involved females and children were more likely to have injuries compared to males and adults. Most of the cases that presented with adverse events of the oral use of a toothbrush were referred for treatment to a physician. CONCLUSIONS The combined evidence related to serious adverse events as presented in case reports showed that the oral use of a toothbrush can be associated with ingestion, impaction, instant trauma, gingival traumatic injury and seizures. Given the incidence of reporting, important recommendations are that a toothbrush should not be used to induce vomiting, nor should people walk or run with this device in their mouths, especially children.
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Affiliation(s)
- Sara Cioccari Oliveira
- Department of Periodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam , The Netherlands
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Saricicek V, Sahin L, Mizrak A, Sen E. Endotracheal intubation of a paediatric patient with an umbrella wire embedded in the palate to the posterior wall of the nasopharynx using a GlideScope video laryngoscope. BMJ Case Rep 2014; 2014:bcr-2014-204478. [PMID: 25342032 DOI: 10.1136/bcr-2014-204478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The penetration of foreign bodies into the oropharynx can be life-threatening. Airway management in patients who have a foreign body penetrated into their oropharynx is a challenging problem for the anaesthetist. In this case report, we aimed to share our experience of endotracheal intubation performed with GlideScope video laryngoscopy in a 3-year-old, 15 kg patient. The patient underwent general anaesthesia to facilitate the removal of an umbrella wire that had become embedded in her soft palate.
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Affiliation(s)
- Vahap Saricicek
- Department of Anesthesiology, University of Gaziantep, Gaziantep, Turkey
| | - Levent Sahin
- Department of Anesthesiology, University of Gaziantep, Gaziantep, Turkey
| | - Ayse Mizrak
- Department of Anesthesiology, University of Gaziantep, Gaziantep, Turkey
| | - Elzem Sen
- Department of Anesthesiology, University of Gaziantep, Gaziantep, Turkey
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The tin whistle: a rare and serious cause of penetrating oropharyngeal trauma in children. Case Rep Emerg Med 2014; 2014:562418. [PMID: 25197581 PMCID: PMC4147197 DOI: 10.1155/2014/562418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/23/2014] [Indexed: 11/18/2022] Open
Abstract
Impalement injuries of the oral cavity are common in children and the potential for serious complications including internal carotid artery thrombosis can be unnoticed. We present a patient who sustained a penetrating injury in which a "tin whistle" caused herniation of the parotid gland which was not detected on clinical examination. We discuss the challenging clinical examination, the role of investigations, and consequences of these injuries aiming at increasing awareness and optimizing patient management.
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Abstract
In many respects, craniofacial trauma in children is akin to that in adults. The appearance of fractures and associated injuries is frequently similar. However, the frequencies of different types of fractures and patterns of injury in younger children vary depending on the age of the child. In addition, there are unique aspects that must be considered when imaging the posttraumatic pediatric face. Some of these are based on normal growth and development of the skull base and craniofacial structures, and others on the varying etiologies and mechanisms of craniofacial injury in children, such as injuries related to toppled furniture, nonaccidental trauma, all-terrain vehicle accidents, and impalement injuries.
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Affiliation(s)
- Bernadette L Koch
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Leith R, O'Connell AC. A foreign body in disguise. Eur Arch Paediatr Dent 2013; 14:359-62. [PMID: 23801078 DOI: 10.1007/s40368-013-0060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Young children habitually place objects in their mouths to discover and learn about the world and it is considered a normal stage of early childhood development. Ingestion and aspiration of foreign objects predominantly occurs in preschool toddlers with a peak incidence at age three years, and can have serious consequences. CASE REPORT A 2-year-old boy presented to the Dublin Dental University Hospital with a tooth-coloured mass tightly adherent to a lower primary incisor. The lesion surrounded the cervical third of the crown on the lower right primary central incisor and extended subgingivally. The tooth was mobile but with minimal inflammation. TREATMENT The tooth was subsequently extracted under general anaesthesia to reveal that the mass was in fact a foreign body, although this was originally thought unlikely as a cause. FOLLOW-UP The patient underwent an unremarkable recovery. CONCLUSION The case of a foreign body disguised as a tooth-like abnormality was only identified under general anaesthesia, and even then it was impossible to prise the object from the tooth in situ. Misdiagnosis of impacted foreign bodies in young children presents complicated diagnostic problems.
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Affiliation(s)
- R Leith
- Department of Public and Child Dental Health, Trinity College Dublin, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland,
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Abstract
Oro-cranial penetrating injuries are often seen in ear, nose and throat practices. Cases of penetrated pencil injuries are rarely reported despite being common in the developing world. A 7-year-old boy referred from a neighboring hospital was playing at school with the sharp end of a pencil in his mouth when he was pushed from behind by another child. He fell on his face and the sharp end of the pencil penetrated his throat with the distal end hanging out. There was no bleeding at presentation, as the pencil completely sealed the entrance point. The entrance point was at the posterior wall of the oropharynx corresponding to the uvulo-palatine junction. It penetrated posterosuperiorly through the soft tissue to reach the anterior part of the posterior cranial fossa. Since sharp and pointed objects in the upper aerodigestive tract can result in potentially fatal complications, prompt diagnosis, a systematic treatment protocol, and an experienced trauma team are necessary to prevent a potential catastrophe.
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Affiliation(s)
- Shuaib K Aremu
- Department of Ear, Nose and Throat, Ibrahim Babangida Specialized Hospital, Minna, Niger State, Nigeria.
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Syebele K, Van Straten C, Chidinyane L. Oral and oropharyngeal impalement injury in pediatric patients--focus on rural environment. Int J Pediatr Otorhinolaryngol 2012; 76:1113-6. [PMID: 22608943 DOI: 10.1016/j.ijporl.2012.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/12/2012] [Accepted: 04/14/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article describes a case series of oral and oropharyngeal impalement injuries in pediatric patients and highlights the peculiar etiological role of the rural environment. STUDY DESIGN The records of nine pediatric patients who presented with oropharyngeal impalement injuries were reviewed. The patients were all from various rural areas of South Africa. The article focuses on the challenges and risk of post-impalement injury infection in the context of a rural environment. RESULTS There were eight boys and one girl. The ages of the study participants ranged from 2 to 10 years. Object-to-head injury was the predominant etiopathogenic mechanism (six cases) compared with head-to-object injury (three cases). Six out of nine lesions were shallow. The hard palate was the single most commonly affected site. Two cases (2/9) of post-impalement injury infection were recorded. CONCLUSION Although the risk of infection post-oropharyngeal impalement injury is reported to be low, it remains, however, a legitimate concern in cases occurring in the rural environment. The specific challenges in terms of health infrastructures in the rural environment, especially in developing countries, may have an impact on the ways oropharyngeal impalement injuries are managed.
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Affiliation(s)
- Kabunda Syebele
- Department of Maxillo-Facial and Oral Surgery, University of Pretoria, South Africa.
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Impalement Injuries of the Oral Cavity in Children. J Oral Maxillofac Surg 2011; 69:e147-51. [DOI: 10.1016/j.joms.2010.12.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 12/26/2010] [Accepted: 12/28/2010] [Indexed: 11/19/2022]
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Kato T, Nasu D, Kaneko T, Horie N, Kudo I, Shimoyama T. Oral impalement injuries by a toothbrush in children. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ajoms.2009.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fatal facial–intracranial impalement injury in an accidental fall from a height: An autopsy case report with a review of the literature. Forensic Sci Int 2010; 200:e21-4. [DOI: 10.1016/j.forsciint.2010.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 03/10/2010] [Accepted: 04/07/2010] [Indexed: 11/18/2022]
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Orszagh M, Zentner J, Pollak S. Transorbital intracranial impalement injuries by wooden foreign bodies: Clinical, radiological and forensic aspects. Forensic Sci Int 2009; 193:47-55. [DOI: 10.1016/j.forsciint.2009.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 09/01/2009] [Indexed: 11/17/2022]
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Rocha AC, Bernabé DG, Filho GA, Júnior JG, Machado GG. Foreign Body in the Hard Palate of Children and Risk of Misdiagnosis: Report of 3 Cases. J Oral Maxillofac Surg 2009; 67:899-902. [DOI: 10.1016/j.joms.2008.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
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Severe oropharyngeal trauma caused by toothbrush – case report and review of 13 cases. Br Dent J 2008; 205:443-7. [DOI: 10.1038/sj.bdj.2008.893] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2008] [Indexed: 11/08/2022]
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Abstract
Penetrating oropharyngeal trauma (OPT) is common in young children. Complications are rare but can be severe and with delayed onset. Controversy exists about the evaluation and management of OPT, although most injuries in the stable child can be managed in the outpatient setting. Two pediatric OPT cases and a brief review of the literature are presented.
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