Five little monkeys jumping on the bed...

In the book Five Little Monkeys Jumping on the Bed by Eileen Christelow, the mischievous monkeys carelessly take to jumping on the bed against their doctor’s orders.  While the story is entertaining, and all is well that ends well, when this happens in real life, significant injuries can occur.

Penetrating palate trauma from kids jumping on the bed with an object in their mouth, or even just running around is a common cause for a visit to the emergency department.  While the great majority of these cases result in little more than a laceration or contusion (bruise) to the soft palate, significant problems can arise from such an injury. 

Because of the shape of the palate and the fact it has both a bony (hard palate) and muscular (soft palate) component, objects tend to be directed to the back of the throat.  Here, the soft tissue of the soft palate is easily penetrated by these objects which range from wiffle ball bats to pens and pencils.  Obviously, if the object is sharp, it is likely to penetrate into these structures more deeply.

Fortunately, the lining of the back of the throat includes firm layers of fibrous tissue (fascia) in front of bone (spine) and are infrequently significantly injured.  Unfortunately, penetrating injuries to the soft palate can result in a defect which goes into the nose.  This can, if not treated properly, result in a hole between the 2 cavities (oro-nasal fistula).  This can end up causing a change in voice and reflux of things through the nose when eating and drinking.  Furthermore, it can be very challenging to repair.

More concerning, however, are the structures which lay to the sides of the throat.  Large blood vessels which come from the heart (the carotid arteries) travel right along side the throat.  While they do sit a little deeper in the neck, and, as a result, are infrequently penetrated by the object, the carotid arteries can be bruised by the object resulting in the formation of a blood clot.  This can alter blood flow and potentially travel to the brain and cause a decrease in blood flow or stroke.  While this is very uncommon, with only 32 reported cases through 2006, this injury can be prevented by good supervision of children and early education not to run, jump, or play with objects in their mouths.

The treatment for most injuries involves observation, primarily of the child’s mental status after the injury.  If the wound is far enough away from the midline, your doctor may recommend a CT scan to look at the structure of the arteries.  Surgery is needed only if the laceration is very large, there is a flap of tissue present, a through-and-through injury is suspected into the nose, or there are retained foreign bodies within the wound.  

So while the five little monkeys all ended up at the doctor thanks to quick action by their ‘mama’, everyone survived without significant injury, and fell fast asleep.