Penetrating aerodigestive injuries and the role of computed tomography esophagography.

Background: Penetrating neck injuries can be fatal if not quickly identified; however, operative intervention is not always necessary. Prompt evaluation with imaging studies aids in identifying patients who need intervention.

Methods: A retrospective, single-center study of patients with PNI from 2017 to 2022 was performed. Management, outcomes, and mortality were compared. Sensitivity and specificity were calculated for imaging studies performed.

Results: Of 436 patients with PNI, 72 had an aerodigestive injury: 42(58 ​%) underwent operative management, and 30(42 ​%) underwent nonoperative management. There was no difference in mortality. The sensitivity and specificity of computed tomography (CT) esophagography for hypopharyngeal/esophageal injury were 100 ​%. The sensitivity and specificity of fluoroscopic esophagography were 71 ​% and 99 ​%. The sensitivity and specificity of combined fluoroscopic esophagography and flexible esophagoscopy were 100 ​%.

Conclusion: In select patients with penetrating aerodigestive injuries, nonoperative management is safe. CT esophagography alone may be sufficient to identify a hypopharyngeal/esophageal injury.