Esophageal, pharyngeal, and tracheolaryngeal injury can occur from ingestion of bases (alkalis or caustics), acids, and bleaches. Children represent the largest group of caustic injuries, resulting mostly from accidental ingestion. Most adult caustic injuries are suicide attempts.
Ingestion of base-containing substances produces the most significant injury because bases cause liquefactive necrosis, which allows deep penetration of the caustic material.28 Such substances include lye (NaOH and KOH), ammonia (NH4OH4), hair relaxers, hair straighteners, and electric dishwasher soaps. Small amounts of caustic materials can cause significant injury.28 The injury associated with alkaline substances is completed almost immediately on mucosal contact. Acidic substances cause less severe injury because they cause a coagulation necrosis, which tends to limit extension into the muscular layer. 28
Patients presenting with caustic injuries of the upper aerodigestive tract display a wide variety of symptoms and physical findings, depending on the anatomic area of involvement (Tabje.,235-4). Studies have failed to show a consistent relationship between symptoms and signs and the ability to predict the severity of injury. 2829 and30 Absence of oropharyngeal lesions does not exclude esophageal, gastric, or tracheal injury. Eight to 20 percent of patients without oropharyngeal lesions have esophageal burns.30 Conversely, the presence of oropharyngeal lesions does not necessarily mean that the esophagus or trachea is involved.
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