Severe complications associated with oral cavity and oropharyngeal injuries caused by a toothbrush

Abstract

Oral cavity and oropharyngeal injuries caused by a toothbrush are often encountered in children and can occasionally lead to severe complications, including mediastinitis and deep neck infections, depending on the direction of the entry wound. We report four cases of severe oral cavity and oropharyngeal injuries that required admission to our hospital. CT evaluation revealed deep neck emphysema in all the cases, although the wounds in the oral cavity were only slight in 3 of the cases. Case 1, a 2-year-old boy, struck his toothbrush into the retropharyngeal wall and developed dyspnea. He developed a severe infection and widespread emphysema extending from the deep neck to the mediastinum, and required mechanical ventilation. Case 2, a 2-year-old girl developed emphysema in the left parapharyngeal space following trauma from a toothbrush that became impaled in the posterior faucial pillar. Case 3, a 13-year-old girl, developed emphysema that extended into the upper retropharyngeal space. Case 4, a 31-year-old woman, developed emphysema and swelling around the right submandibular gland and parapharyngeal space. All cases were conservatively treated with intravenous antibiotics. Considering our cases, CT examination for foreign body remnants as well as emphysema and deep space infections is strongly recommended in the evaluation of oral cavity and oropharyngeal injuries, regardless of the severity of the oral wound.