Uchino Hayaki, Kuriyama Akira, Kimura Kenji, Ikegami Tetsunori, Fukuoka Toshio
Department of Emergency Medicine, Kurashiki Central Hospital, Okayama, Japan.
Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan.
J Emerg Trauma Shock. 2015 Apr-Jun;8(2):115-8. doi: 10.4103/0974-2700.145403.
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.
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.
儿童穿刺伤可能比预期的更深且更复杂。我们遇到了两例意外穿刺伤病例，一例经口腔，另一例在颈部。我们回顾这些病例以及这类损伤的处理方法。
病例1中，一名20个月大的女孩嘴里含着牙刷从桌子上摔下。她意识清醒，没有明显的神经或血管损伤。检查发现右咽后壁有一处2毫米的裂伤伴小血肿。增强计算机断层扫描（CECT）显示气道在下颌支和颈椎之间穿行，经过颈动脉鞘，到达右后颈部皮肤下方。手术性气肿从咽部延伸至纵隔。病例2中，一名3岁女孩拿着铅笔摔倒。体格检查发现右耳垂前方有一处5毫米的裂伤伴小血肿。她的面部运动不对称，右眼无法闭合。CECT显示右侧腮腺肿胀，强化不均匀，右颈动脉鞘前方有游离气体，提示异物穿透腮腺。诊断为周围性面神经损伤。医生需要意识到儿童穿刺伤可能危及生命的并发症，以及与特定解剖结构邻近相关的特定并发症。
