Penetrating Oropharyngeal Trauma in a 9-Year-Old Child Following Fall with Foreign Object

Case at a Glance

A 9-year-old male presented to the emergency department following a fall down stairs while holding a bamboo skewer in his mouth, resulting in penetrating trauma to the oropharyngeal region with concern for airway involvement.

Patient's Story

The patient, a 9-year-old male weighing 56 pounds and measuring 4'7" in height, sustained an injury after falling down stairs while carrying a bamboo skewer in his mouth. The child immediately experienced severe pain and began crying. He reported pain with swallowing and speaking, with visible bleeding in the tonsillar area. Despite initial distress, the patient's condition stabilized, and he expressed hunger shortly after the incident. His medical history is significant for ADHD, currently managed with Adderall.

Initial Assessment

Upon presentation, the patient was alert and cooperative but complained of throat pain and difficulty swallowing. Physical examination revealed bleeding in the oropharyngeal region, specifically around the tonsillar area, though no active hemorrhage was noted. The patient was able to speak, though with discomfort. Initial vital signs were stable, and the airway appeared patent.

The Diagnostic Journey

Given the mechanism of injury and potential for serious complications including carotid artery injury, esophageal perforation, or airway compromise, the medical team proceeded with a comprehensive evaluation. A food challenge was administered using a popsicle to assess the patient's ability to swallow safely and to monitor for signs of occult bleeding or esophageal injury. The test evaluated both swallowing function and potential blood ingestion that might indicate ongoing internal bleeding.

Final Diagnosis

Superficial oropharyngeal trauma without evidence of major vascular injury, esophageal perforation, or significant airway compromise. The injury was determined to be limited to the superficial tissues of the oropharynx and tonsillar region.

Treatment Plan

Conservative management was implemented with close observation for signs of complications. The patient was monitored for symptoms of infection, bleeding, or delayed complications such as fever, chest pain, or respiratory distress. Instructions were provided for immediate return if any concerning symptoms developed over the following days, particularly signs suggestive of deep space infection or delayed vascular injury.

Outcome and Follow-up

The patient tolerated the food challenge well, demonstrating adequate swallowing function without evidence of aspiration or significant bleeding. He was discharged home in stable condition with specific instructions to return immediately if symptoms such as fever, chills, chest pain, shortness of breath, or increased bleeding developed. Follow-up care was arranged to monitor for delayed complications, which can occur with penetrating oropharyngeal injuries even when initial presentation appears benign.