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Esophageal puncture may occur as part of an oropharyngeal stick injury. Acutely affected dogs display oral and cervical pain. Marked soft tissue swelling and subcutaneous emphysema are often identified (Figure 4.16a, b), together with drooling of sanguineous saliva. Pharyngeal puncture is very seldom life threatening, even when associated with an underlying track of traumatized tissue, but may evolve into a chronic abscess or discharging sinus [6]. In addition, foreign material is more difficult to surgically locate, once an abscess or suinus has developed, in comparison with exploration of the acute case, even with the assistance of advanced imaging. Esophageal wall breach may lead to a syndrome of descending fasciitis and mediastinitis, which may prove fatal [6]. Endoscopic assessment of esophageal integrity, after foreign body retrieval, may provide a useful complement to other imaging modalities, although hemorrhage and mucosal swelling may impair visualization. Survey radiographs appear to be a sensitive modality with which to identify perforation [6] via the presence of emphysema within the cervical tissues (Figure 4.16b), although this does not distinguish between pharyngeal and esophageal perforation. A careful oral and pharyngeal examination using two long‐bladed, brightly illuminated laryngoscopes may reveal a site of injury. This inspection alone does not rule out additional puncture sites arising from a stick entering the esophageal aditus and perforating the esophageal wall more distally. Endoscopic examination of the esophagus is well suited to further characterize the extent of the patients' injuries. Advanced imaging techniques are also very useful for identifying foreign bodies in the tissues of the neck (Figure 4.16c).

Figure 4.17 A splinter of wood being retrieved during a ventral midline exploration of a dog's neck.

It is not understood why esophageal perforation may foster such a fulminant course. Investigators of descending necrotizing mediastinitis following dental abscess rupture or foreign body impalement injuries in humans speculate on the presence of corridors for infection within tissue planes of the neck [20, 21]. Dogs with this condition require aggressive stabilization followed by early cervical exploration for repair of esophageal perforations, retrieval of foreign material (Figure 4.17), debridement and lavage of the affected tissues, and endoscopic placement of a gastrostomy tube. A ventral midline cervical approach affords good access to the entire cervical esophagus.