Acute airway obstruction following facial scalding: differential diagnosis between a thermal and infective cause

A 16-month-old boy received a 6 per cent hot water scald to his face and chest. The child had been suffering from an upper respiratory tract infection for 10 days prior to the injury. However, as the child rapidly developed respiratory tract obstruction, a differential diagnosis between acute infective epiglottitis and thermal injury to the hypopharynx was required. In fact, the hot water had reached the epiglottis and the aryepiglottic folds causing significant damage, whilst sparing the tongue and mouth. The child was admitted to the intensive care unit, intubated and ventilated for days. The external burns eventually healed spontaneously. This case report demonstrates the rare occurrence of a minor scalding injury resulting in significant obstruction to the upper airway. Of additional interest is the presence of pre-existing symptoms of an upper respiratory tract infection and the total absence of any signs of intraoral burning. These additional factors demonstrate the necessity for absolute vigilance in the management of any scald in the region of a childʹs mouth. Intubation can be life saving and should be considered in any case of scalding associated with increasing respiratory distress.