Noninvasive versus Rigid Endoscopic Evaluation of Upper Aerodigestive Tract in Penetrating Neck Trauma

Abstract

Objectives: (1) Describe the effectiveness of current diagnostic modalities in diagnosing upper aerodigestive tract injuries. (2) Recognize the potential complications of rigid endoscopy in trauma patients. Methods: This is a retrospective chart review of patients admitted between January 1998 to May 2008 with penetrating neck trauma in all zones who underwent assessment with physical examination, barium swallow, computed tomography, and/or endoscopy. The sensitivity and specificity of these modalities were calculated and compared. Results: Physical examination appears to be unreliable due to poor sensitivity in this study. Direct laryngoscopy appears to be more sensitive than flexible laryngoscopy. Bronchoscopy was not frequently performed and 1 patient (2%) had tracheal repair diagnosed with rigid bronchoscopy. Rigid esophagoscopy was performed more commonly than flexible esophagoscopy. Both types of esophagoscopies detected the 2 (4%) esophageal injuries. Computed tomography scan was nonspecific due to presence of subcutaneous air in most patients. Barium swallow had a 100% negative predictive value in our study and did not miss any injuries. There were 5 patients (10%) who had postprocedure symptoms that can be potentially attributed to rigid endoscopy including teeth injury, and upper and lower extremity weakness and paresthesias. Conclusions: Barium swallow appears to be a reliable study which did not miss any significant injuries. Endoscopic studies, especially rigid ones, carry a risk of C-spine complications that should be recognized in trauma patients.