36 - Neck Trauma

Abstract

Blunt and penetrating neck trauma can cause significant cervical artery, airway, and pharyngoesophageal injuries. Although the neck is divided into three zones, injuries may occur in multiple zones or zones other than that of the entry point. Penetrating cervical artery injuries can be recognized by hard signs (strongly predictive of an injury) or soft signs (indicating potential for an injury and need for further work-up). Blunt cervical artery injuries put patients at risk of delayed stroke, and screening criteria exist to identify patients at risk of arterial injury. Pharyngoesophageal injuries are rare but associated with a high mortality, especially when diagnosis is delayed. Laryngotracheal injuries can cause immediate airway compromise and mandate intervention. Typically, an attempt at oropharyngeal intubation with a surgical airway available is recommended. Hangings are a specific type of blunt injury, which can lead to anoxic brain injury and pulmonary edema in addition to neck injuries. Multidetector CT angiogram is a reasonable initial study, but high-risk patients may require adjunctive evaluation for certain injuries. Treatment is based on the type and degree of injury.