Selective management of penetrating neck injuries using “no zone” approach

Injury ◽  
2015 ◽  
Vol 46 (9) ◽  
pp. 1720-1725 ◽  
Author(s):  
Supparerk Prichayudh ◽  
Jirat Choadrachata-anun ◽  
Suvit Sriussadaporn ◽  
Rattaplee Pak-art ◽  
Sukanya Sriussadaporn ◽  
...  
Keyword(s):  
Neck Injuries ◽  
No Zone Approach

scholarly journals Effectiveness of No-Zone Approach for Management of Isolated Penetrating Neck Injuries Among Hemodynamically Stable Patients. A Longitudinal Retrospective Study.

2020 ◽  
Author(s):  
Ahmed Gaber Hassanein ◽  
Mohammed Hazem Elmoshneb ◽  
Wael A. Ahmad ◽  
Ahmed Abdel Kahaar Aldardeer ◽  
Osama A. Ismail
Keyword(s):  
Nerve Repair ◽  
Vascular Complications ◽  
Neurological Complications ◽  
Neck Injuries ◽  
Standard Management ◽  
Management Protocol ◽  
Treatment Plans ◽  
Tomographic Angiography ◽  
Traditional Approaches ◽  
No Zone Approach

Abstract Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of nontherapeutic surgeries, and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography to guide treatment plans. This work aimed to study the effectiveness and reliability of no-zone approach for management of isolated PNIs in hemodynamically stable patients. Methods: cases of isolated PNIs in hemodynamically stable patients were managed using no zone approach. Detected injuries were managed accordingly. Results: This study included 106 patients. 34.9% of patients were managed conservatively while surgery was done at 65.09%. Vascular management was done in 40.57%, laryngotracheal repair in 29.2%, tracheostomy in 17%, pharyngeal repair in 7.55%, esophageal repair in 6.6%, and accessory nerve repair in 2.83%. Complications occurred in 16.04% of cases in the form of vascular complications (7.5%), respiratory complications (5.7%), pharyngoesophageal complications (1.9%), infections (12.3%), and neurological complications (7.5%). The survivors were 91.5% while deaths were 8.5%. Conclusion: The no-zone approach offers the ideal management for isolated PNIs in hemodynamically stable patients. It is advantageous over traditional approaches. Further studies are required to augment the evidence for its use as the gold standard management for such cases. Trial registration: the study was retrospectively registered at research registry with Research Registry UIN researchregistry5385 on February 26, 2020. Keywords: no zone approach, isolated penetrating neck injuries, hemodynamically stable patients, vascular injuries, laryngotracheal injury.

scholarly journals A tailored protocol in management of penetrating neck injuries: experience at a level 1 trauma centre

2021 ◽  
Vol 8 (2) ◽  
pp. 516
Author(s):  
Ahmed M. Elshaer ◽  
Hussein O. Elwan ◽  
Doaa A. Mansour
Keyword(s):  
Trauma Centre ◽  
P Value ◽  
Neck Injuries ◽  
Conservative Group ◽  
Missed Injuries ◽  
Asymptomatic Patients ◽  
Tailored Approach ◽  
Zone Ii ◽  
Sensitivity Specificity ◽  
No Zone Approach

Background: The management of penetrating neck injuries (PNIs) evolved markedly over last year’s towards more conservative approaches. Recent improvements in imaging modalities as multi-detector CT-angiography (MDCT-A) produced a paradigmatic shift towards 'no-zone' approach. In this study, we adopted a tailored protocol to deal with such injuries with less dependency on zone classification.Methods: This prospective study included patients with PNIs from February 2012 to January 2014. Unstable patients and patients with hard signs in zone-II were managed by immediate exploration. Patients with hard signs in zones-I and III had MDCT-A to check feasibility of endovascular intervention. However, all patients with soft signs and asymptomatic patients underwent MDCT-A regardless the zone affected to determine the need for therapeutic intervention. Complementary investigations were added in some cases with equivocal MDCT-A results.Results: Our study included 85 patients. Majority were males (94%; n=80) with mean age 27±4. Stabs were the main causative injury (51%; n=43). 63 (74%) patients were stable; with majority (64%; n=40/63) were symptomatic (18 presented with hard signs and 22 presented with soft signs). 53 (62%) patients had MDCT-A with sensitivity, specificity of 77%, 97% respectively and significant p value <0.05. After applying this protocol, we avoided 37% (31/85) non-therapeutic neck exploration, with only 4 (7.4%) negative cases on exploration. We experienced no missed injuries in the conservative group, yet 2 (3.7%) missed nerve injuries were encountered in intervention group.Conclusions: Zones-classification is losing popularity nowadays and shouldn't be the cornerstone of the new management protocols in PNIs. This selective tailored approach can be effectively used in management of PNIs. It avoids missed injuries and unnecessary explorations significantly.

scholarly journals Validity of no-zone approach for management of isolated penetrating neck injuries in hemodynamically stable patients

2021 ◽  
Author(s):  
Kamal A. M. Hassanein ◽  
Osama A. Ismail ◽  
Islam A. Amer ◽  
Ahmed Abdel Kahaar Aldardeer ◽  
Tarek Elsayed Ftohy ◽  
...  
Keyword(s):  
Neck Exploration ◽  
Neck Injuries ◽  
Current Management ◽  
Missed Injuries ◽  
Safe Management ◽  
Management Protocol ◽  
Tomographic Angiography ◽  
Complications And Mortality ◽  
No Zone Approach ◽  
Rule Out

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of unnecessary interventions and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography (CTA) to guide treatment. The aim was to assess the validity of the no-zone approach in the management of isolated PNIs in hemodynamically stable patients.Methods: This retrospective study included patients with isolated PNIs with soft signs who were hemodynamically stable. They were classified into patients with negative CTA findings and were managed conservatively and patients with positive CTA findings suspecting aerodigestive tract injuries (ADTIs) who were submitted to further selective investigations to confirm or rule out these injuries. Detected injuries were managed accordingly.Results: This study included 106 PNIs patients who had soft signs and were hemodynamic stable. 37 cases (34.9%) had negative CTA findings and were managed conservatively. Sixty nine patients (65.1%) had positive CTA findings and were subjected to subsequent selective investigations and revealed 3 patients with negative endoscopic findings who passed without need for any surgical intervention. Therefore, 40 (37.7%) patients were saved from surgery with no missed injuries. Patients with definitive injuries (66 patients) underwent neck exploration and managed accordingly. No missed injuries were recorded in this study. Complications were detected in 6 cases (5.7%) while death was recorded in 2 cases (1.9%).Conclusions: No-zone approach offers a safe management protocol for isolated PNIs in hemodynamically stable patients. It provides no missed injuries, negligible rates of negative exploration and minimal complications and mortality.

‘No zone’ approach to the management of stable penetrating neck injuries: a systematic review

2021 ◽  
Author(s):  
Meera L. Chandrananth ◽  
Andrew Zhang ◽  
Catherine R. Voutier ◽  
Anita Skandarajah ◽  
Benjamin N. J. Thomson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neck Injuries ◽  
No Zone Approach

scholarly journals Head and neck injuries after leopard attack: presentation and management

2021 ◽  
Author(s):  
Padmanidhi Agarwal ◽  
Ajay Dhiman ◽  
Nouman Rashid ◽  
Ruby Kataria
Keyword(s):  
Head And Neck ◽  
Neck Injuries

scholarly journals Penetrating Neck Injuries Treated at a U.S. Role 3 Medical Treatment Facility in Afghanistan During Operation Resolute Support

2020 ◽  
Author(s):  
John Breeze ◽  
William G Gensheimer ◽  
Joseph J DuBose
Keyword(s):  
Medical Treatment ◽  
Emergency Room ◽  
Neck Region ◽  
Neck Injuries ◽  
Treatment Facility ◽  
Medical Treatment Facility ◽  
Trauma Registries ◽  
Neck Wound ◽  
Major Injury ◽  
High Negative Predictive Value

ABSTRACT Introduction Military trauma registries can identify broad epidemiological trends from neck wounds but cannot reliably demonstrate temporal casualty from clinical interventions or differentiate penetrating neck injuries (PNI) from those that do not breach platysma. Materials and Methods All casualties presenting with a neck wound to a Role 3 Medical Treatment Facility in Afghanistan between January 1, 2016 and September 15, 2019 were retrospectively identified using the Emergency Room database. These were matched to records from the Operating Room database, and computed tomography (CT) scans reviewed to determine damage to the neck region. Results During this period, 78 casualties presented to the Emergency Room with a neck wound. Forty-one casualties underwent surgery for a neck wound, all of whom had a CT scan. Of these, 35/41 (85%) were deep to platysma (PNI). Casualties with PNI underwent neck exploration in 71% of casualties (25/35), with 8/25 (32%) having surgical exploration at Role 2 where CT is not present. Exploration was more likely in Zones 1 and 2 (8/10, 80% and 18/22, 82%, respectively) compared to Zone 3 (2/8, 25%). Conclusion Hemodynamically unstable patients in Zones 1 and 2 generally underwent surgery before CT, confirming that the low threshold for exploration in such patients remains. Only 25% (2/8) of Zone 3 PNI were explored, with the high negative predictive value of CT angiography providing confidence that it was capable of excluding major injury in the majority of cases. No deaths from PNI that survived to treatment at Role 3 were identified, lending evidence to the current management protocols being utilized in Afghanistan.

Postmortem Radiology of Head and Neck Injuries in Fatal Traffic Accidents

Radiology ◽  
1975 ◽  
Vol 114 (3) ◽  
pp. 611-617 ◽  
Author(s):  
George J. Aiker ◽  
Young S. Oh ◽  
Eugene V. Leslie ◽  
Judith Lehotay ◽  
Victor A. Panaro ◽  
...  
Keyword(s):  
Head And Neck ◽  
Traffic Accidents ◽  
Neck Injuries

Feel the Burn! Fireworks-related Otolaryngologic Trauma

2021 ◽  
pp. 000348942110081
Author(s):  
Alexander J. Straughan ◽  
Luke J. Pasick ◽  
Vrinda Gupta ◽  
Daniel A. Benito ◽  
Joseph F. Goodman ◽  
...  
Keyword(s):  
United States ◽  
Head And Neck ◽  
Emergency Departments ◽  
Closed Head Injury ◽  
Penetrating Trauma ◽  
The United States ◽  
Neck Injuries ◽  
Chi Square ◽  
Injury Surveillance System ◽  
Cross Sectional

Objectives: Fireworks are used commonly for celebrations in the United States, but can lead to severe injury to the head and neck. We aim to assess the incidence, types, and mechanisms of head and neck injuries associated with fireworks use from 2010 to 2019. Methods: A retrospective cross-sectional study, using data from the National Electronic Injury Surveillance System, of individuals presenting to United States Emergency Departments with head and neck injuries caused by fireworks and flares from 2010 to 2019. Incidence, types, and mechanisms of injury related to fireworks use in the US population were assessed. Results: A total of 541 patients (349 [64.5%] male, and 294 [54%] under 18 years of age) presented to emergency departments with fireworks-related head and neck injuries; the estimated national total was 20 584 patients (13 279 male, 9170 white, and 11 186 under 18 years of age). The most common injury diagnoses were burns (44.7% of injuries), laceration/avulsion/penetrating trauma (21.1%), and otologic injury (15.2%), which included hearing loss, otalgia, tinnitus, unspecified acoustic trauma, and tympanic membrane perforation. The remaining 19% of injuries were a mix, including contusion, abrasion, hematoma, fracture, and closed head injury. Associations between fireworks type and injury diagnosis (chi-square P < .001), as well as fireworks type by age group (chi-square P < .001) were found. Similarly, associations were found between age groups and injury diagnoses (chi-square P < .001); these included children 5 years and younger and adults older than 30 years. Conclusions: Fireworks-related head and neck injuries are more likely to occur in young, white, and male individuals. Burns are the most common injury, while otologic injury is a significant contributor. Annual rates of fireworks-related head and neck injuries have not changed or improved significantly in the United States in the past decade, suggesting efforts to identify and prevent these injuries are insufficient.

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