Injury of the pharynx is external and internal damage to its walls, which arise when the impact of traumatic factor.
The most common consequences of injuries of the pharynx are impaired swallowing, speech function and breathing, quite massive bleeding. But also, this pathology can be combined with traumatic cervical spine and spinal cord, sinuses of the nose, throat, large nerve trunks and blood vessels in such cases the symptoms will be more diverse.
In some cases the injury is so severe the throat, which requires measures aimed at relief of pain. Delayed treatment of this pathology can cause a number of severe complications in the pharynx and neighboring structures.
The pharynx participates in providing two vital processes of swallowing and breathing, so the trauma may lead to their violation.
In the soft tissues of the neck near the body are equally important structures of the body:
- sympathetic trunks and ganglia (nerve knots);
- vagus nerve;
- the cervical spinal column;
- cervical part of the esophagus;
- the main (Central) vessels – the carotid artery.
For this reason, injuries of the pharynx are not only dangerous themselves, but also threatens more serious consequences, is fraught not only for health, but for life.
Depending on how damaging agent is acting on tissues, injuries of the pharynx is divided into 2 large groups:
- outer – strength of the traumatic factor is applied from the outside, through the soft tissue of the neck;
- inner – traumatic factor damages the tissue of the pharynx from the inside, from the side of its lumen when it gets into as a result of accidental or intentional actions.
In many cases, trauma to the pharynx is observed as cross-cutting in the pathological process involved both internal and external surface of the throat. Therefore, for subsequent treatment, does not matter, the traumatic agent was from the inside or the outside. But the mechanism of injury are useful for understanding damaged only one wall of the pharynx or injured structures that are nearby.
The mechanism of injury of the pharynx are:
- mechanical – provoked by the mechanical effects on the pharyngeal wall;
- thermal they thermal burns (injuries incurred under the influence of high temperature);
- chemical – they are chemical burns (damages caused by the harsh chemicals).
This pathology is diagnosed in all age groups – from children to the elderly. Women and men are affected approximately equally often.
Mechanical injuries of the pharynx occur more frequently than others. In wartime, their number in the structure of all injuries of this organ increases sharply and ranges from 90 to 95% of all diagnosed cases.
This article will analyze the mechanical injury of the pharynx.
Causes injury of the pharynx can be:
- medical manipulations;
- traumatic actions that are not related with the treatment process.
To the injury of the pharynx can lead medical manipulations:
Most often, injuries of the pharynx arise during such diagnostic procedures, such as:
- production of a nasogastric tube for extraction of gastric contents;
- production of duodenal probe to fence the contents of 12 duodenal ulcer (in particular, bile);
- laryngoscopy is examination of the larynx using the laryngoscope;
- fibroesophagogastroduodenoscopy – study of different parts of the digestive tract from esophagus to duodenum 12 with the fiberscope (a kind of endoscope with integrated optical system and lighting)
- bronchoscopy – examination of the state of the inner surface of the bronchi using bronchoscope (a kind of endoscopic equipment);
- diagnostic biopsy of tissues or structures of the pharynx airway (larynx, trachea, bronchi) – collection of fragments of the suspicious tissue for further examination under a microscope
and some others.
Injury of the pharynx can occur when carrying out such medical procedures as:
- probing of the esophagus – an alternate introduction to a special metal rods of different diameter to expand the lumen of the esophagus;
- removal of foreign bodies in the pharynx and/or esophagus;
- removal of foreign body from the airway – larynx, trachea and bronchi;
- production of a nasogastric tube for decompression (unloading) of the stomach;
- setting nazogastralny probe for parenteral feeding;
- surgery on the pharynx or adjacent structures
and some others.
Trauma to the throat during the medical procedures involves:
- careless or rough manipulation;
- a deviation from a predetermined sequence of actions;
- urgent situations when you have to act quickly.
Injury of the pharynx not connected with medical manipulations, can be:
Unintentional trauma to this organ occurs because:
- sloppy and/or careless actions of a person;
- in an accident (although often accidents can also be interpreted as a consequence of carelessness and negligence).
Injury of the pharynx, connected with the human factor (in particular, negligence) are largely critical, often is injured:
- fish or animal bone;
- foreign object when it is accidentally splashed in the throat (for example, if a person is in a state of alcoholic intoxication);
- objects dining with their careless use
and so on.
External trauma to the pharynx occurs as the result of accidents of different degrees of difficulty – from a fall while Cycling to major car accidents, train wrecks, burial under rubble during the earthquake and so on.
Intentional injury of the pharynx can be applied:
- by the victim;
- other persons.
In the first case, this can happen when you try:
The harm observed from the outside:
- individuals trying to get to the hospital, to avoid administrative, criminal or social responsibility;
- individuals with demonstrative type of behavior;
- individuals who adhere to traditions and rituals – including those associated with damage to your own body;
- mentally ill people;
- people in a condition of strong alcoholic intoxication or under severe influence of drugs.
Injury of the pharynx can be caused to the person:
- a mentally ill person;
- criminal elements;
- as a result of domestic violence;
- during paramilitary actions, revolutions, riots, coups, war.
In peacetime, injuries to the pharynx often occur during fights.
The development of the pathology
Mechanical injuries of the pharynx are:
- injury foreign body.
Localization of the wound there are injuries:
- of the nasopharynx;
- of the oropharynx;
- of the hypopharynx.
Also they are divided into:
- received in wartime.
The mechanism of development of injuries of the pharynx are:
- combined – in addition to the pharynx, traumatic agent damage the neighboring structures;
- combined are injuries that occur when exposed to multiple traumatic agents (mechanical and thermal, mechanical and chemical).
All exterior mechanical injury of the pharynx are by default combinedas to “get there” purely to the throat, damaging agent penetrates through arrays of soft tissues of the neck and face (when exposed on the rear surface of the neck – injuries to bone structures of the cervical spine).
Symptoms of injury of the pharynx
The clinical picture of injury of the pharynx consists of signs such as:
- the presence of the wound defect (hole);
- pain syndrome;
- a breathing disorder.
Type of injury depends on the traumatic agent – it can be in the form of scratches, scraps of fabric, a long, narrow defect in the tissues and so on.
Characteristics of pain:
- localization in the area of the wound defect;
- widespread pain can involve the entire neck;
- nature – aching, burning, “vomiting”;
- intensity – depending on extent of injury can vary from unexpressed to unbearable;
- in appearance – pain noted at the time of injury, then, depending on the extensiveness of the injury and the accession of complications may subside or increase.
Bleeding in injuries of the pharynx can be observed from the wound, mouth and/or nose.
Impaired swallowing has been observed in almost any variety of injuries of the pharynx.
Respiratory distress appears when:
- this form of the wound surface, in which fragments of tissue to close the lumen of the pharynx;
- the fracture of the hyoid bone;
- damage to the muscles of the pharynx;
- the tongue.
In combined injuries of the pharynx can be observed, and other clinical symptoms.
In combined injury of the pharynx, and nerve trunks were observed:
- paresis of the larynx – a violation of its motional activity;
- violation of articulation – the man can’t talk normally, in cases of severe injuries are not able to speak at all;
- aphagia – the inability to make even the slightest swallowing movements;
- stop breathing.
In combined injury of the pharynx and larynx disorders of voice.
In combined injury of the pharynx and the paranasal sinuses (ethmoid, frontal and sphenoid) are observed:
In combined injuries of pharynx and cervical spine, in most cases, comes death.
Injury of the pharynx is a dangerous pathology, because in many cases (in addition to the risk of death because of the combination with spinal cord injury) develop severe consequences, incompatible with life is:
- massive blood loss – as a consequence of profuse bleeding;
- mechanical asphyxia – the complete absence of air passage because of falling of the walls of the pharynx or the obstruction of foreign object;
- acute stenosis of the larynx – develops due to edema after a traumatic and may lead to asphyxia;
- reflex stop breathing.
- traumatic shock – the disruption of the microcirculation on the background of severe pain syndrome.
The diagnosis is based on complaints, anamnesis (present fact of injury) and examination (visualized by the wound surface). If the victim is unconscious, it is important to clarify the circumstances of injury in accompanying the patient. Additional methods of diagnostics are used to specify the degree of injury and detection of complications.
Data examination the following:
- on examination – external injury of the pharynx on the surface of the visible neck wound. When viewed to appreciate the size of the wound, degree of bleeding, presence of foreign objects in it. To reveal the wound, sometimes you need to be very thorough inspection of the skin, as it can be chipped, and the outer opening of the wound channel can not notice immediately. Also the purpose of the inspection is to assess the General condition of the victim.
If the household is diagnosed internal injury of the pharynx, are the following additional methods of examination:
- pharyngoscope – inspection of the pharynx with a spatula and reflector. Estimated place of trauma and the state of the neighboring tissues;
- laryngoscopy is examination of the larynx using the laryngoscope (variety of endoscopic equipment mounted with the optical and illuminating systems). Used to exclude or confirm concomitant injuries of pharynx and larynx.
If, in addition to the injury of the pharynx, confirmed the fact of injury of the larynx, are conducting a study on voice function. With this objective involves such methods of diagnostics as:
- stroboscopy (indirect laryngoscopy with the use of intermittent light) – using a special camera strobe estimate of the vibrational capabilities of the vocal cords;
- foetoscope – acoustic analysis of the voice of the patient. It uses a special computer program;
- electroglottography – assessment of the mobility of the larynx and vibrations of the vocal cords. This measured electrical resistance of the larynx, which is written in the form electroglottography (varieties oscillogram).
When external associated injuries for its assessment involved the following additional methods:
- ultrasonic examination of soft tissues of the neck (ultrasound) – helps to identify the injured structures of the neck;
- computed tomography of the pharynx (CT) – with the help of computer sections it is possible to obtain more detailed information than ultrasonography;
- magnetic resonance imaging (MRI) – challenges and opportunities is virtually the same as CT;
- radiography of the cervical spine is drawn under the suspicion of his injury;
- computed tomography of the paranasal sinuses is essential for the assessment of paranasal sinuses, if there is pronounced nasal bleeding and liquorrhea;
- computed tomography of the skull will help confirm or rule out concomitant injuries of the pharynx and structures of the skull.
Laboratory methods that are used in the diagnosis of injuries of the pharynx, the following:
- General analysis of blood – with the development of infectious complications observed increase in the number of leukocytes and erythrocyte sedimentation rate, massive bleeding, signs of anemia – decrease in the number of erythrocytes and hemoglobin;
- bacterioscopic study – under the microscope learn the material from the throat, determine the causative agent well in advance to appoint antibiotics to prevent infectious complications injury to the throat;
- bacteriological examination – make a sowing of the throat at the content of the nutrient medium, colonies appeared identificeret of the pathogen and determine its sensitivity to antibiotics, which is important for future medicinal purposes.
In urgent cases, when the throat injury threatens the life, its diagnosis is carried out intraoperative – during emergency surgery.
Differential diagnosis of
Differential diagnosis of injuries of the pharynx should be performed with injuries of adjacent organs and tissues – primarily this injury:
- of the larynx;
- of the esophagus;
- the great vessels and major nerve trunks.
The most frequent complications of injuries of the pharynx are:
- external bleeding is due to the violation of the integrity of the walls of major blood vessels;
- retropharyngeal abscess – a limited abscess on the back of the throat;
- parapharyngeal abscess – limited ulcer, literally surrounding the throat;
- cicatricial stenosis of the pharynx – it is the narrowing due to scar tissue that is formed in the case of marked injury to the pharyngeal wall;
- perichondrium of the larynx – inflammation of the larynx pericentre (thin connective tissue film, which covers her cartilage);
- cellulitis of the neck – diffuse purulent lesion tissue neck;
- mediastinitis – inflammation (often purulent) mediastinal structures and tissue, which are located between the two lungs;
- aspiration pneumonia – pneumonia that developed due to the ingress of blood into the respiratory tract;
- sepsis – a massive infection spread by the bloodstream throughout the body, often with the formation of a secondary infectious and inflammatory foci in other organs and tissues;
- arrosive bleeding – it develops due to the fact that the formed pus literally “eats” the wall of the blood vessel;
- evstahiit – inflammatory process in the auditory tube;
- hemotympanum – accumulation of blood in the tympanic cavity of the middle ear;
- acute otitis media – inflammation of middle ear structures;
- hearing loss – hearing impairment.
The last four complications develop as a consequence of injuries of the nasopharynx.
Treatment and first aid for injuries of the pharynx
For external injuries of the pharynx it is necessary to quickly provide first aid. The most important actions are:
- stop bleeding;
- the resumption of air passing through the throat into the respiratory tract.
Hemostasis is carried out by methods such as:
- the finger pressure of the carotid artery;
- the imposition of a pressure bandage on the wound.
Resumption of breathing is performed by asphyxia, it is produced by tracheostomy – forming an artificial opening in the trachea.
Victims exposed throat wound must be immediately hospitalized in the clinic. In a hospital environment are:
- primary surgical processing of wounds, if necessary – removal of foreign objects (pieces of clothing, earth, debris, etc.);
- anti-shock activity;
- the introduction of tetanus toxoid;
- in severe epistaxis – posterior nasal packing, which is tight in the introduction of a soft, sterile material into the cavity of the nose;
- when neustanovivshiesya bleeding – ligation of the external carotid artery;
- production of a nasogastric tube for parenteral feeding of a patient, if he has injury due to impaired swallowing;
- drug therapy.
The basis of medical treatment – the following nominations:
- anti-inflammatory drugs;
- painkillers. When expressed pain syndrome prescribe narcotic analgesics;
- decongestant drugs;
- detoxification therapy – intravenously administered electrolytes, salt and protein solutions, glucose;
- transfusion of blood and blood components in severe bleeding.
In severe injuries of the pharynx will require a restoration of its normal form to this effect after stabilization of the patient’s condition, or carry out reconstructive plastic surgery.
When unexpressed household internal injuries shown:
- antibiotic therapy;
- gargle the throat with antiseptic solutions;
- periodic inspection of the otolaryngologist.
The basis of prevention of injuries of the pharynx – the following events and actions:
- careful completion of diagnostic and therapeutic manipulation;
- neat attentive behavior in everyday life;
- avoidance of conflict situations, of a mass congestion of people (particularly aggressive – for example, during a sports competition or concert);
- avoidance of contacts with the mentally ill and other people with inappropriate behavior.
The prognosis of injuries of the pharynx depends on the degree of their severity and injury of the adjacent structures (especially the vitally important spinal cord, nerves and major blood vessels).
Internal domestic injuries of the pharynx, the prognosis is always favorable, if the victims in a timely manner go to the clinic and get appropriate treatment. Prognosis is affected by complications that develop due to late referral to a specialist.