Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 12 , ISSUE 2 ( May-August, 2023 ) > List of Articles


Novel Classification and Proposal Guide for the Management of Hypopharynx Trauma

Orlando Favio Arevalo Guerra, Adriana M Zuñiga, Mario A Herrera, Henry Giraldo, Christian Muñoz, Wilmer Perez, Michael Zapata, Adolfo G Hadad

Keywords : Conservative treatment, Hypopharynx, Penetrating neck trauma, Severity scales, Trauma surgery

Citation Information : Guerra OF, Zuñiga AM, Herrera MA, Giraldo H, Muñoz C, Perez W, Zapata M, Hadad AG. Novel Classification and Proposal Guide for the Management of Hypopharynx Trauma. Panam J Trauma Crit Care Emerg Surg 2023; 12 (2):70-75.

DOI: 10.5005/jp-journals-10030-1422

License: CC BY-NC 4.0

Published Online: 19-08-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: The management of noniatrogenic penetrating trauma to the hypopharynx remains controversial due to its uncommonness and limited evidence to support management protocols. The present study's primary goal is to describe the management of noniatrogenic penetrating hypopharyngeal trauma (THF) in a tertiary hospital in Colombia. The secondary goal is to present a novel classification and management guide for such injuries. Study design: Case series collected retrospectively from the hospital trauma registry between January 2021 and April 2022. THF was categorized as grade I–IV according to a new classification (described below) and correlated with the clinical outcome at hospital discharge. The data collection and analysis were done using the Epi InfoTM software. Quantitative variables were presented as mean and/or mean according to the distribution. Qualitative variables were presented as frequency and percentages. The outcomes of each patient are described. Results: Over the study period, 31 patients were admitted to the emergency department with penetrating neck trauma in zone II and III. Fourteen of the 31 had a hypopharyngeal injury, one required surgical management, and 13 were managed conservatively. The male/female gender ratio was 13/1, the mean injury severity score (ISS) was 8, revised trauma scores (RTS) was 7, the mean age was 31 years, and zone II (8/14, 58%) was the most affected area. Retrospectively analyzing the injuries and applying the proposed classification, we found that: Nine patients (64%) had a grade I injury, three (21%) had a grade II, one had a grade III, and one had a grade IV. The use of the AREVALO Hypopharynx University Valle (HUV) classification and management guide reduced the average hospital stay from 4 to 1 day mostly by allowing immediate oral feeding, thus reducing the need for enteral nutrition. Only one patient underwent surgical repair. All other 13 patients were successfully managed nonoperatively, of whom 10 were followed up after discharge, and none developed any complications. Conclusion: The proposed novel classification may optimize the care of patients with a penetrating injury of the hypopharynx by standardizing the management of this uncommon entity and preventing the trauma care team from unnecessary overtreatment of patients with low-grade lesions.

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