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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
A 7 year old boy presents after injuring his lateral soft palate with a straw. He is completely asymptomatic and exam other than what is shown is normal.
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November 3, 2019 at 7:10 am
Hennelly K et al, Incidence of morbidity from penetrating palate trauma, Pediatrics 2010;126:e1578-84 reported on a retrospective cohort of 205 patients aged 9 months to 18 years (median age 40 months) with penetrating palate injury (71% lateral soft palate). Although 49% were admitted, none had stroke (95% CI 0-2.5%), and only 1 developed infection (0.9%, 95% CI 0-5.3%). 90 (44%) underwent CTA, and 9 (10%) of those were positive, but none with positive CTA required surgery. The authors conclude that morbidity from penetrating palatal injury in a well-appearing child is extremely low.
A review article by Randall DA & Kang DR, Otolaryngol Head Neck Surg 2006;135(3):356-60 recommends antibiotics for lacerations > 1-2 cm or contaminated, surgical repair of through-and-through wounds or large, avulsed, or hanging flaps, and imaging & hospitalization if there is evidence of neurovascular injury on exam (eg neurologic deficit, carotid bruit, ongoing bleeding). Uptodate’s algorithm recommends imaging for lateral, deep posterior wounds, but not for superficial low-force injuries, especially if they are midline. Discharge home requires a reliable caretaker with means to return if necessary
January 31, 2020 at 1:49 pm
ENT consult and do what they say. If not available, unless I think there is a carotid injury in which case I do CT angio, I reassure and send home.