Ear, Nose, Throat and Neck Injury: Part II

Abstract

This chapter deals with trauma of the anterior and lateral cervical triangles (Fig. 1). Note the following points: 1. The neck is separated into compartments by strong fascial envelopes. The critical organs in the anterior and lateral triangles are mobile and protected by strong muscles and fibroelastic connective tissue; thus, approximately half of the patients with penetrating neck trauma have no significant injury. 2. Blunt neck trauma may result in severe tissue injury. The primary consideration is the maintenance of an adequate airway. 3. Open or penetrating wounds of the neck are frequently associated with significant vascular involvement. An expanding mass within the neck may be a sign of vascular injury. 4. Airway patency can be jeopardized by a progressive soft-tissue swelling due to hemorrhage, edema, infection, or subcutaneous emphysema. 5. Bleeding from the mouth may indicate mid-neck vascular (e.g., carotid) disruption. 6. Gunshot wounds produce a wide track of damaged tissue, often requiring segmental resection and end-to-end anastomosis or grafting of the injured vessel or organ. 7. An obstructed airway or hypovolemic shock requires immediate surgical exploration. 8. Stable patients should be constantly observed and examined carefully for evidence of trauma to the vascular, neural, airway, or digestive tracts.