Traumatic hypopharyngeal perforation and pneumomediastinum from a toothbrush

Background

Hypopharyngeal injuries are infrequently described, and management is extrapolated from the literature on esophageal perforations. Cases may present with associated pneumomediastinum and are associated with high morbidity and mortality, particularly if there is a delay in diagnosis.

Case Report

A 52-year-old man presented with dyspnea and neck swelling after inserting a toothbrush into his throat when he thought he was developing an allergic reaction to sushi. He had extensive neck and chest crepitus, with pneumomediastinum identified on chest x-ray. Flexible laryngoscopy was used to directly identify a posterior pharyngeal perforation. The patient was hemodynamically stable without signs of sepsis, and the otolaryngology consultant deferred surgical intervention. He was successfully treated with conservative medical management and made a full recovery.

Why should an emergency physician be aware of this?

Hypopharyngeal perforation is a rare diagnosis with high morbidity and mortality. Early diagnosis, broad-spectrum antibiotics, and early surgical consultation are essential to minimize complications of this rare presentation.