頸部鈍傷造成下咽部破損－病例報告

Hypopharyngeal Perforation after Blunt Neck Trauma - Case Report

黃山崧(Shan-Sung Huang) ； 朱本元(Pen-Yuan Chu)

《中華民國耳鼻喉科醫學會雜誌》 32卷5期 (1997/10) Pp. 463-467

https://doi.org/10.6286/1997.32.5.463

摘要

部鈍傷造成單的下咽部損傷很少見，臨床表現有吞嚥困難、吞嚥疼痛、頸部疼痛、皮下氣腫，嚴重時可能造成呼吸困難危及生命。處理原則應先維持通暢的呼吸道，下咽部缺損處的縫合，則依破損程度施行修補手術。本部於民國85年5月經歷1病例，患者於清晨騎機車不慎撞到停在路旁的卡車，安全帽帶將其頸部向後拉扯。檢查現後咽壁自會厭軟骨至食道入口有明顯撕裂傷，同時在皮下、咽後、側咽旁、上縱隔腔有明顯氣腫，於是立刻施行暫時性的氣切，維持呼吸道暢通，並施予經口內縫合手術，以及經由側頸部放置引流管。術後病人呼及、吞嚥及發聲功能恢復良好。(中耳醫誌 1997:32;463-467)

關鍵字

下咽部破損 ； 頸鈍傷

並列摘要

Isolated hypopharyngeal perforation as a result of blunt trauma to the neck is rare. The clinical presentations are dysphagia, odynophagia, neck pain and subcutaneous emphysema. If the condition is misdiagnosed and treated inappropriately, airway obstruction and life-threatening infectious complications may occur. The principles of management are to create an adequate patents airway and to close the hypopharyngeal defect. We encountered a motorcyclist who struck a parked truck. Examination revealed posterior pharyngeal wall lacerations from the epiglottis level to the esophageal inlet. Apparent emphysema in the retropharyngeal and parapharyngeal spaces was also noted. The patient first underwent a temporary tracheostomy to secure the airway, followed by a lateral cervical approach with drainage and intraoral primary closure of the lacerated wound. The post-operative conditions of respiration, swallowing and phonation were uneventful.

並列關鍵字

hypopharyngeal perforation ； blunt neck trauma