Carotid-Threatening Penetrating Oropharyngeal Trauma in a Pediatric Patient: A Case Report and Literature Review

TL;DR

A 7-year-old boy suffered a rare oropharyngeal injury near his carotid artery after being pushed into a locker with a pencil in his mouth.

Contribution

This case highlights the rare but serious risk of vascular injury in pediatric penetrating oropharyngeal trauma.

Findings

The pencil was less than 1 mm from the left internal carotid artery with no extravasation or dissection.

The object was safely removed without complications under ketamine sedation.

Abstract

Penetrating oropharyngeal injury is a relatively common occurrence in pediatric patients; however, cases involving close proximity to critical vascular structures, such as the internal carotid artery (ICA), are exceedingly rare and pose significant risks. This case report describes a seven-year-old male who sustained penetrating oropharyngeal trauma with startling proximity to the ICA after being pushed into a locker with a pencil in his mouth. Initial evaluation showed the wooden pencil protruding from the soft palate without active bleeding. CT angiography revealed that it was less than 1 mm from the left ICA, with no signs of extravasation or dissection. The pencil was removed atraumatically under ketamine sedation, and the puncture site was irrigated without complications. In patients presenting with penetrating oropharyngeal trauma, injury to the internal carotid or adjacent vessels with possible resulting extravasation or dissection should be considered. This is a single case report accompanied by a literature review.

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