Finding | Minor | Moderate | Severe |
Mechanism | Low force: eg, Fall from the sitting position with toy in the mouth | Intermediate force: eg, Fall while running with pencil in mouth OR Bicycle accident while eating a popsicle | High force: eg, High speed motor vehicle accident with impaling oropharyngeal object OR Penetrating injury with knife or gunshot wound |
Wound appearance | Mucosal laceration <2 cm in length OR Superficial midline puncture wound | Submucosal laceration >2 cm in length OR Tonsillar or lateral soft palate deep or indeterminate depth puncture wound OR Protruding or retained foreign body* | Large, gaping wound with copious bleeding OR As for moderate injury with associated neurovascular findings |
Associated findings | Superficial gum laceration or abrasion | Tooth fracture, luxation, or avulsion Tongue laceration Jaw fracture | Neurologic abnormality carotid artery bruit on side of injury |
Radiographic imaging | Not indicated | CTA or contrast enhanced MRA¶ | Digital subtraction CAA |
CTA: computed tomography angiography; MRA: magnetic resonance angiography; CAA: carotid artery angiogram.
* A protruding oropharyngeal foreign body should only be removed in the operating room.
¶ Contrast enhanced MRA is preferred if available and if the patient can cooperate with not moving for 30 to 60 minutes.