THÔNG TIN TÀI LIỆU
Children with severe intraoral injuries or punctures can be acutely ill on presentation or deteriorate quickly These patients should be seen emergently For patients with injury to the oral pharynx who appear stable and are awaiting evaluation, careful and frequent reassessment for change in condition is prudent Initial Assessment A history of objects in the mouth, possible foreign bodies, or bleeding from the oral cavity should raise concern for intraoral injuries A thorough oral examination for lacerations, hematomas, and foreign objects should be performed Expanding neck hematoma, persistent oral bleeding, or diminished pulses in the neck are signs of vascular injury and require immediate attention Management Oral lacerations rarely require suturing unless a large flap (or defect greater than to cm) exists For nonoperative injuries, oral hygiene with warm saline rinses can keep the area clean (see Chapter 105 Dental Trauma ) Antibiotics are not routinely indicated If concern exists for a retained foreign body, imaging with CT is warranted Superficial foreign bodies can usually be removed in the ED Deeper foreign bodies are most safely removed in the OR which is better suited for management of potential complications and allows wound exploration following removal Children with suspected vascular injury should undergo CT or MRI with angiography Children with isolated oral injuries may be safely discharged home Those suspected to have retained foreign body or vascular injury should be definitively imaged and admitted for further treatment if indicated (see Fig 106.2 ) Caustic Injuries Injuries resulting from ingestion of caustic substances such as lye or acid may cause burns to the oral mucosa, pharynx, proximal esophagus, or as far distally as the stomach Injuries caused by basic chemicals are far more serious than those caused by acidic ones The former creates a liquefactive necrosis that is often deeper and causes more damage than the coagulative necrosis caused by acids Identifying the ingested agent is critical in managing the patient with caustic burns Skip lesions are possible, with no injuries initially visible on examination Patients with definite ingestion of known caustic substances should undergo endoscopy within 12 to 24 hours to assess the extent of injuries (see Chapter 102 Toxicologic Emergencies ) The role of steroids has been debated; some data suggest benefit in reducing the risk of strictures while other studies had not
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