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consistent with exposure to such pressure changes. The treatment for sinus
barotrauma is supportive, with pain control and antimicrobials.

TRAUMA TO THE ORAL CAVITY AND PHARYNX
Goals of Treatment
The emergent goal in oral and pharyngeal injuries is to evaluate and protect the
airway when at risk for compromise or obstruction. In addition, the emergency
clinician must identify serious injuries that may involve vascular structures or
wounds that may lead to infection. Oral and pharyngeal foreign bodies should be
removed promptly due to risk of aspiration. Ingestion and aspiration is covered in
detail in Chapter 32 Foreign Body: Ingestion and Aspiration , Chapter 91
Gastrointestinal Emergencies , and Chapter 124 Thoracic Emergencies .
CLINICAL PEARLS AND PITFALLS
Falls with objects in the mouth may result in injuries to the vascular
structures, potentially resulting in CNS complications.
Foreign bodies may be retained in the oral cavity.

Current Evidence
A common etiology of oral cavity injury is biting of the cheek causing a
laceration or hematoma. Palatal injuries are usually caused by a foreign body,
often as a result of falling with something in or around the patient’s mouth. Risk
of associated injury can be stratified based on location of the trauma within the
oral cavity. Central hard or soft palate injuries are not likely to be associated with
neurovascular injury. Lateral palate, especially soft palate or tonsillar fossa is
associated with vascular injury given the close proximity to the carotid sheath.
Posterior pharyngeal wall injuries may be associated with vascular injuries
resulting in hematoma and risk of infection.

Clinical Considerations
Clinical Recognition
Oral or pharyngeal injuries in children often result from a fall, foreign body,

ingestion, or blow from a projectile object such as a ball.
Triage