Blunt Pharyngoesophageal Injuries: Current Management Strategies

Blunt pharyngoesophageal injuries pose a management challenge to the trauma surgeon. The purpose of this study was to explore whether these injuries can be managed expectantly without neck exploration. The National Trauma Databank datasets 2007–2011 were reviewed for blunt trauma patients who sustained a pharyngeal injury, including an injury to the cervical esophagus. Patients who survived over 24？h and were not transferred from other institutions were divided into two groups based on whether a neck exploration was performed. Outcomes included mortality and hospital stay. A total of 545 (0.02%) patients were identified. The median age was 18？years and 69% were male. Facial fractures were found in 16%, while 13% had an associated traumatic brain injury. Of the 284 patients who survived over 24？h and were not transferred from another institution, 65 (23%) underwent a neck exploration. The injury burden was significantly higher in this group as indicated by the higher median Injury Severity Score (17 vs 10, p？<？0.01) and need for intensive care unit admission (75% vs 31%, p？<？0.01). The overall mortality was 2%: 3.1% for neck explorations versus 1.6% for conservative management (adjusted p？=？0.54). Neck exploration patients were more likely to remain longer in the hospital (median 13 vs 10？days, adjusted p？=？0.03). Pharyngoesophageal injuries are rare following blunt trauma. Only a quarter require a neck exploration and this decision appears to be dictated by the injury burden. Selective non-operative management based on clinical status seems to be feasible and is not associated with increased mortality