Penetrating neck injury: case report and evaluation of management

2000 ◽  
Vol 114 (7) ◽  
pp. 554-556 ◽  
Author(s):  
M. Tariq ◽  
A. Kalan ◽  
S. S. Surenthiran ◽  
A. Bhowmik
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Effective Means ◽  
Neck Injury ◽  
Urban Violence ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Specific Approach ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma

Greater urban violence has resulted in an increased incidence of penetrating neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic dilemmas. The evaluation and management of such injuries, however, remains controversial. There is no universally accepted specific approach to the management of patients with penetrating neck injuries, with some surgeons advocating mandatory neck exploration whilst others believe in selective surgical intervention.We believe that an equal willingness for both conservative and surgical intervention as dictated by serial bedside evaluation with adequate radiological and endoscopic support can provide the clinician a safe and effective means of managing a potentially complex and lethal problem.

scholarly journals Penetrating neck injuries: a guide to evaluation and management

2018 ◽  
Vol 100 (1) ◽  
pp. 6-11 ◽  
Author(s):  
JL Nowicki ◽  
B Stew ◽  
E Ooi
Keyword(s):  
Life Support ◽  
Neck Injury ◽  
Helical Computed Tomography ◽  
Advanced Trauma Life Support ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Injury Management ◽  
Operative Exploration ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma

IntroductionPenetrating neck injury is a relatively uncommon trauma presentation with the potential for significant morbidity and possible mortality. There are no international consensus guidelines on penetrating neck injury management and published reviews tend to focus on traditional zonal approaches. Recent improvements in imaging modalities have altered the way in which penetrating neck injuries are now best approached with a more conservative stance. A literature review was completed to provide clinicians with a current practice guideline for evaluation and management of penetrating neck injuries.MethodsA comprehensive MEDLINE (PubMed) literature search was conducted using the search terms ‘penetrating neck injury’, ‘penetrating neck trauma’, ‘management’, ‘guidelines’ and approach. All articles in English were considered. Articles with only limited relevance to the review were subsequently discarded. All other articles which had clear relevance concerning the epidemiology, clinical features and surgical management of penetrating neck injuries were included.ResultsAfter initial resuscitation with Advanced Trauma Life Support principles, penetrating neck injury management depends on whether the patient is stable or unstable on clinical evaluation. Patients whose condition is unstable should undergo immediate operative exploration. Patients whose condition is stable who lack hard signs should undergo multidetector helical computed tomography with angiography for evaluation of the injury, regardless of the zone of injury.ConclusionsThe ‘no zonal approach’ to penetrating neck trauma is a selective approach with superior patient outcomes in comparison with traditional management principles. We present an evidence-based, algorithmic and practical guide for clinicians to use when assessing and managing penetrating neck injury.

Use of a Gum Elastic Bougie in a Penetrating Neck Trauma

2014 ◽  
Vol 29 (2) ◽  
pp. 212-213 ◽  
Author(s):  
Yann Daniel ◽  
Stanislas de Regloix ◽  
Eric Kaiser
Keyword(s):  
Neck Injury ◽  
Military Hospital ◽  
Anatomical Landmarks ◽  
Neck Trauma ◽  
Publication Type ◽  
Aeromedical Evacuation ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma ◽  
Laryngeal Cartilages ◽  
Hostile Environments

AbstractThe case of a patient with a zone II penetrating neck injury who was intubated successfully utilizing the gum elastic bougie (GEB) is reported. He presented at a forward operational base in Afghanistan with a shrapnel wound in his neck as well as a cough and hoarseness. There were two wounds on each side of his laryngeal cartilages. The patient's breathing rate gradually increased and labored inhalation developed while the aeromedical evacuation was delayed for tactical reasons. Subcutaneous emphysema and edema concealed the anatomical landmarks, making a cricothyrotomy unsafe, and no fiber optic devices were available on site. Intratracheal intubation was decided upon by the doctors involved. Because of the anticipated difficultly of intubation, the GEB was used from the outset. During direct laryngoscopy, edema, blood, and mucus concealed the anatomic reliefs of the larynx. The glottis was not visible. On the second attempt, “clicks” were clearly perceived and the tube was railroaded over the bougie. Finally, the patient was evacuated to an Afghan military hospital.In this report, the benefit-risk balance for the use of the GEB in penetrating neck trauma is discussed. Although the use of the GEB cannot be recommended in all cases of penetrating neck injury, it should be considered as an option. This technique is not without risk, but in very remote settings or hostile environments, especially when cricothyrotomy is not possible, it can be lifesaving.DanielY, de RegloixS, KaiserE. Use of a gum elastic bougie in a penetrating neck trauma. Prehosp Disaster Med. 2014;29(2):1-2.

scholarly journals Conservative management of laryngeal perforation in a rural setting: case report and review of the literature on penetrating neck injuries

CJEM ◽  
2011 ◽  
Vol 13 (02) ◽  
pp. 127-132 ◽  
Author(s):  
Michael R. Kolber ◽  
Anne Aspler ◽  
Richard Sequeira
Keyword(s):  
Case Report ◽  
Care Management ◽  
Standard Of Care ◽  
Rural Setting ◽  
Neck Injuries ◽  
Review Of The Literature ◽  
Significant Morbidity ◽  
Neck Trauma ◽  
Penetrating Neck Trauma ◽  
Rule Out

ABSTRACTPenetrating neck injuries (PNIs) are infrequent but can result in significant morbidity and mortality. Although surgical management of unstable patients with penetrating neck trauma is the standard of care, management of stable patients remains controversial owing to the possibility of occult injuries. Recent studies suggest that physical examination and ancillary imaging may be sufficiently accurate to diagnose or rule out surgically significant injuries in PNI. We report a patient with a laryngeal perforation who was managed conservatively in a rural hospital without complications and review the literature pertinent to cases of this nature.

The Use of the Anatomic ‘Zones’ of the Neck in the Assessment of Penetrating Neck Injury

2014 ◽  
Vol 80 (10) ◽  
pp. 970-974 ◽  
Author(s):  
Garren M. I. Low ◽  
Kenji Inaba ◽  
Konstantinos Chouliaras ◽  
Bernardino Branco ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Gunshot Wounds ◽  
Neck Injury ◽  
Neck Trauma ◽  
External Zone ◽  
Penetrating Neck Injury ◽  
Internal Structures ◽  
High Incidence ◽  
Penetrating Neck Trauma ◽  
External Wound

The traditional classification of neck injuries uses an anatomic description of Zones I through III. The objective of this article was to characterize the association between external wounds and the corresponding internal injuries after penetrating neck trauma to identify the clinical use of the anatomic zones of the neck. Patients who sustained penetrating neck trauma from December 2008 to March 2011 were analyzed. All patients underwent structured clinical examination documenting the external zone where the wound(s) were located. All internal injuries were then correlated with the external wounds. An internal injury was defined as “unexpected” if it was located outside the borders of the neck zone corresponding to the external wound. In total, 146 patients sustaining a penetrating neck injury were analyzed; 126 (86%) male. The mechanism of injury was stab wounds in 74 (51%) and gunshot wounds in 69 (47%). Mean age was 31 years (range, nine to 62 years). Thirty-seven (25%) patients sustained had a total of 50 internal injuries. There was a high incidence of noncorrelation between the location of the external injury and the internal structures that were damaged in patients with hard signs of vascular or aerodigestive injury. The use of the anatomic zones and their role in the workup of penetrating neck injury are questionable.

scholarly journals Penetrating Neck Injury: Mandatory exploration versus conservative approach

2016 ◽  
Vol 9 (4) ◽  
Author(s):  
Muhammad Hamid Majid ◽  
Mahmood Ayyaz ◽  
Faraz Fahim
Keyword(s):  
Hospital Stay ◽  
Anatomical Landmarks ◽  
Conservative Approach ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Cervical Trauma ◽  
Mortality And Morbidity ◽  
Conservative Group ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma

This study is designed to investigate the outcome of patients managed on both conservative as well as operative protocols and then compare the two groups for morbidity and mortality. It is a comparative study comparing the groups of patients with operative and non operative intervention done for penetrating neck trauma at Mayo Hospital Lahore for a period of six years from September 1995 to August 2001. All patients of age more than 12 years of age presenting with penetrating cervical trauma in our emergency were included in study. In patients with multiple injuries mortality and morbidity of only cervical trauma was compared. Neck was divided in to three zones according to recognized anatomical landmarks. In conservative group 38.9% developed complications where as in other group 46.4%, developed complications This difference was not significant (p=0.05) Mean hospital stay was 10 days in the conservative group where as 4 days in other group which was statistically significant. Hence we conclude that patients with penetrating neck injuries who are clinically stable can be managed conservatively after appropriate investigations.

Pneumomediastinum due to Penetrating Neck Injury: A Case Report

2019 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Kasım Turgut ◽  
Abdullah Algın ◽  
Hasan Öğünç Apaydın
Keyword(s):  
Case Report ◽  
Neck Injury ◽  
Penetrating Neck Injury

scholarly journals Pneumomediastinum due to Penetrating Neck Injury: A Case Report

2019 ◽  
Vol 20 (3) ◽  
pp. 267-269
Author(s):  
Kasım Turgut ◽  
Abdullah Algın ◽  
Hasan Öğünç Apaydın
Keyword(s):  
Case Report ◽  
Neck Injury ◽  
Penetrating Neck Injury

Penetrating Neck Trauma

2016 ◽  
Author(s):  
Adam R. Kellogg ◽  
B. Witkind Davis
Keyword(s):  
Airway Management ◽  
Diagnostic Testing ◽  
Case Fatality ◽  
Hemodynamic Instability ◽  
Orotracheal Intubation ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Penetrating Neck Trauma ◽  
Surgical Evaluation ◽  
Serious Injuries

Penetrating neck injuries are approximately 1% of all traumatic injuries in the US, yet the case fatality rate approaches 10%. All emergency physicians need to be able to expediently differentiate those requiring emergent interventions from those with less serious injuries. Initial management of penetrating neck injuries focuses on identification of patients requiring early airway management or emergent surgical evaluation. Due to bleeding, anatomic distortion, hemodynamic instability, or potential airway violation patients with penetrating neck trauma should be presumed to have difficult to manage airways. The emergency physician must be prepared to perform cricothyrotomy, and even tracheostomy, should orotracheal intubation attempts fail. Diagnosis of injury in the stable patient with evidence of violation of the platysma has moved away from the traditional zone based approach and now focuses on structured physical exam and the use of MDCTA. Further diagnostic testing may be required dependent on the results of the MDCTA and should be at the direction of a surgeon.   Keywords: Penetrating Neck Trauma, Laryngotracheal Trauma, Carotid Artery Injury, Airway Management, Cricothyrotomy, Surgical Airway, CT Angiography

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