Neck Injuries

Penetrating Neck Injuries

• • first step of evaluating penetrating neck trauma - Evaluate airway. Intubate or surgical airway if expanding neck hematoma, tracheal deviation or obvious tracheal involvement. Fascial layers may limit exsanguinations.

  • Penetrating injury through the platysma must be further evaluated

  • four vessels that must be evaluated - two carotids, two vertebral;

    • CTA or angiography. CTA is faster and safer but angiography has capability of treating vertebral injuries with embolization and carotid injuries with stenting.

  • esophageal injuries evaluated

    • Combination of esophagoscopy and soluble contrast swallow study followed by barium swallow can discover most esophageal injuries. Esophageal injuries need to be evaluated in zones I and II injuries.

Causes of subcutaneous emphysema

• 1. Entrance through wound

  2. Esophageal injury

  3. Tracheal injury

• • selective exploration - Selective exploration is based on diagnostic studies that include A-gram or CT A-gram, bronchoscopy, esophagoscopy

  • indications for surgical exploration in all penetrating neck wounds - “Hard signs” of significant neck damage: shock, exsanguinating hemorrhage, expanding hematoma, pulsatile hematoma, neurologic injury, subQ emphysema