Kevin R. Schwartz
A 2-year-old boy fell while running with a clothes hanger in his mouth. On exam, there is a clothes hanger hanging from his lower mouth. He appears anxious but is maintaining his airway. He is drooling but has no stridor, no active bleeding, no work of breathing, and his lungs are clear. Plain film x-rays were obtained and are shown here.
How should this patient be managed and what complications should he be monitored for?
The patient has penetrating trauma to the floor of the mouth. A number of cases have been reported in the literature of similar injuries. In the majority of cases, surgical removal in the operating room is recommended rather than removal at bedside. The primary immediate complication is bleeding. After removal, the patient should be observed for airway edema. Dexamethasone has been used in an effort to prevent airway swelling though evidence for this application is lacking. Infection has been reported as a later complication in a number of case reports, though there are limited data to support routine antibiotic prophylaxis.
Keywords: airway, head and neck/ENT, penetrating trauma, foreign body.
Chauhan N, Guillemaud J, El-Hakim H. Two patterns of impalement injury to the oral cavity: Report of four cases and review of the literature. Int J Pediatr Otorhinolaryngol August 2006;70(8):1479–83. Cheng J, Kleinberger A, Dunham B. Don’t hang your coat here. Int J Pediatr Otorhinolaryngol 2012;76:750–1.