Fiberoptic laryngoscopy used to determine the origin of mediastinal emphysema: A case report

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We report the case of a 11-month-old girl who fell from a low table with a ballpoint pen in her mouth.When she presented at our hospital, there was no bleeding in her oral cavity, and she did not have dyspnea.A computed tomography scan and a radiograph revealed diffuse cervical subcutaneous emphysema and mediastinal emphysema.On examining her mouth using a penlight, no wound could be detected.Perforation of the piriform recess, trachea, or esophagus requires prompt surgical intervention.On examination using a fliberoptic laryngoscopy, a wound with coagulated blood was observed at the pharyngeal posterior wall.But there was no perforation from trachea to carina.We began oxygen administration, vital sign monitoring, and empiric antibiotic therapy.The patient did not show symptoms of severe infection or signs of respiratory distress.Subcutaneous emphysema and mediastinal emphysema improved immediately.She was discharged 9 d after admission.A delay in the recognition and management of pharyngeal trauma can lead to avoidable complications such as retropharyngeal abscess, mediastinitis, and airway compromise.We concluded that bronchoscopic examinations are minimally invasive and useful for detecting pharyngeal injury.