Penetrating Neck Trauma

Posted by e-Medical PPT Tuesday, March 20, 2012
Introduction
5-10% of all trauma
Overall mortality rate as high as 11%
Major vessel injury fatal in 65%, including prehospital deaths
Mandatory exploration of all penetrating neck wounds, through the platysma
Fogelman and Stewart reported Parkland Memorial Hospital experience of early, mandatory exploration with mortality of 65 vs.. 35% for delayed exploration

Anatomy
Zone I
Bound superiorly by the cricoid and inferiorly by the sternum and clavicles
Contains the subclavian arteries and veins, the dome of the pleura, esophagus, great vessels of the neck, recurrent nerve, trachea
Signs of significant injury may be hidden from inspection in the mediastinum or chest

Zone II
Bound inferiorly by the cricoid and superiorly by the angle of the mandible
Contains the larynx, pharynx, base of tongue, carotid artery and jugular vein, phrenic, vagus, and hypoglossal nerves
Injuries here are seldom occult
Common site of carotid injury

Zone III
Lies above the angle of the mandible
Contains the internal and external carotid arteries, the vertebral artery, and  several cranial nerves
Vascular and cranial nerve injuries common

Penetrating neck trauma

Diagnosis            Signs and symptoms   

Vascular injury        Shock
                                Hematoma       
                                Hemorrhage   
                                Pulse deficit   
                               Neurologic deficit   
                               Bruit or thrill in neck   
Laryngotracheal injury      
                 Subcutaneous emphysema   
                 Airway obstruction   
                 Sucking wound   
                 Hemoptysis   
                 Dyspnea   
                 Stridor   
                 Hoarseness or dysphonia   
Pharynx/esophagus injury 
                 Subcutaneous emphysema   
                 Hematemesis   
                 Dysphagia or odynophagia

Exploration or Observation
Zone I
Adequate exposure for exploration and repair may require sternotomy, clavicle resection, or thoracotomy
High morbidity of exploration, thus suspicion must be great before taking the patient to OR
Cardiothoracic surgery consultation a must
Angiography is essential...

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