Deep Neck Abscess After Intubation Trauma: a Case Report

Overview

Journal Radiol Case Rep

Publisher Elsevier

Specialty Radiology

Date 2022 Jan 6

PMID 34987691

Authors

Kashyap Kaul

Chetan S Nayak

Jessica Jacoby

Kenneth D Katz

Affiliations

Soon will be listed here.

Abstract

Significant injuries from endotracheal intubation are exceedingly rare but can lead to life-threatening complications, such as pharyngeal perforation. This type of perforation can result in abscess formation and airway compromise. Risks for this complication include operator skill and intubation in emergent situations. This case report details a 59-year-old male who underwent elective septoplasty with bilateral nasal turbinate reduction. The procedure required general anesthesia induction and endotracheal intubation. He developed a gradually enlarging right-sided neck mass with associated fevers, neck pain, odynophagia, and dysphonia. He presented to the emergency department on postoperative day 5 and was diagnosed with a right-sided, prevertebral space abscess with airway mass effect secondary to pharyngeal perforation. He was admitted for operative management, intravenous antibiotics, and was successfully treated. While significant injury from endotracheal intubation is rare, it can result in infection and threaten airway patency. Emergency physicians must recognize pharyngeal perforation as a potential source of infection following instrumentation of the pharynx. This case has been reported to increase awareness of the potential for such injury.

References

Stauffer J, Petty T . Accidental intubation of the pyriform sinus. A complication of "roadside" resuscitation. JAMA. 1977; 237(21):2324-5. View

Inoki K, Konda K, Katagiri A, Yamamura F, Yoshida H . Successful Management of Pharyngeal Perforation Caused by Overtube Insertion During Endoscopic Submucosal Dissection. Cureus. 2020; 12(5):e8090. PMC: 7292698. DOI: 10.7759/cureus.8090. View

Lee T, JORDAN J . Pyriform sinus perforation secondary to traumatic intubation in a difficult airway patient. J Clin Anesth. 1994; 6(2):152-5. DOI: 10.1016/0952-8180(94)90017-5. View

Warner M, Fox J . Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet. A A Case Rep. 2015; 6(4):77-9. DOI: 10.1213/XAA.0000000000000235. View

Bartlett D, Grace R, Newell S . Perforation of and intubation through the palatoglossal fold. Anaesth Intensive Care. 2009; 37(3):481-3. DOI: 10.1177/0310057X0903700315. View

Joshi R, Riley C, Kacker A . Complication Rates Following Septoplasty With Inferior Turbinate Reduction. Ochsner J. 2020; 19(4):353-356. PMC: 6928672. DOI: 10.31486/toj.19.0002. View

Cooper R . Complications associated with the use of the GlideScope videolaryngoscope. Can J Anaesth. 2007; 54(1):54-7. DOI: 10.1007/BF03021900. View

Domino K, Posner K, Caplan R, Cheney F . Airway injury during anesthesia: a closed claims analysis. Anesthesiology. 1999; 91(6):1703-11. DOI: 10.1097/00000542-199912000-00023. View

Smith D, Woolley S . Hypopharyngeal perforation following minor trauma: a case report and literature review. Emerg Med J. 2005; 23(1):e7. PMC: 2564152. DOI: 10.1136/emj.2003.012187. View

10.

Salemis N, Georgiou C, Alogdianakis E, Gourgiotis S, Karalis G . Hypopharyngeal perforation because of blunt neck trauma. Emerg Radiol. 2008; 16(1):71-4. DOI: 10.1007/s10140-007-0699-5. View

11.

Hagr A, Kamal D, Tabah R . Pharyngeal perforation caused by blunt trauma to the neck. Can J Surg. 2003; 46(1):57-8. PMC: 3211670. View

12.

Komasawa N, Minami T . Difficult airway management in a patient with combined severe deep neck abscess and acute epiglottitis with abscess. J Clin Anesth. 2014; 26(7):581. DOI: 10.1016/j.jclinane.2014.05.003. View

13.

Levine P . Hypopharyngeal perforation. An untoward complication of endotracheal intubation. Arch Otolaryngol. 1980; 106(9):578-80. DOI: 10.1001/archotol.1980.00790330058016. View

14.

Benedetto C, Tanzariello V, Militi A, Fallica G, Marco D, Monaco F . Catastrophic descending necrotizing mediastinitis of the anterior and posterior compartments: A case report. Radiol Case Rep. 2020; 15(10):1832-1836. PMC: 7417671. DOI: 10.1016/j.radcr.2020.07.040. View

15.

Leong W, Lim Y, Sia A . Palatopharyngeal wall perforation during Glidescope intubation. Anaesth Intensive Care. 2009; 36(6):870-4. DOI: 10.1177/0310057X0803600620. View

16.

Yee A, Christensen D, Waterbrook A, Amini R . Parapharyngeal abscess with tracheal deviation. Intern Emerg Med. 2017; 12(7):1077-1078. DOI: 10.1007/s11739-017-1634-8. View

17.

Jacobs I, Niknejad G, Kelly K, Pawar J, Jones C . Hypopharyngeal perforation after blunt neck trauma: case report and review of the literature. J Trauma. 1999; 46(5):957-8. DOI: 10.1097/00005373-199905000-00033. View

18.

Onishi T, Onishi Y, Tachibana K, Kasano K, Hachiya S, Muramoto H . Perforation of the hypopharynx after transesophageal echocardiography. J Echocardiogr. 2016; 12(2):71-4. DOI: 10.1007/s12574-014-0213-5. View