Blunt Neck Injury Research Articles

Blunt Trauma Neck with Thyroid Cartilage Subluxation with no External Sign

Trauma to the neck can produce catastrophic results as neck houses plethora of vital structures and is relatively an unprotected anatomical territory. Blunt trauma to the neck, excluding cervical spine injuries, represents only 5% of all neck trauma, but can be very challenging to assess since its presentation is often delayed. Penetrating injuries, on the other hand, are more common, and even when they seem to be only superficial and minor, always need thorough investigation and observation. Primary stabilization of the patient followed by an extensive evaluation needs to be done in all cases of neck trauma. CECT neck and thorax along with fibreoptic laryngoscopy remain the main modalities of diagnosis following a neck trauma. The initial approach to any kind of neck injury, whether penetrating or blunt, is performed according current Advanced Trauma Life Support (ATLS) or European Trauma Course (ETC) protocols, which both use the structured ‘ABCD’ approach. A motor vehicle accident (MVA) remains the most common cause of blunt neck injury, causing direct pressure to the anterior neck from the dashboard, steering wheel or airbag deployment. Direct pressure to the neck is transduced to the trachea and causes compression of the oesophagus against the cervical spine. Laryngotracheal trauma continues to be a rare entity and is the second most common cause of death in patients with head and neck trauma after intracranial injury. Only 0.5% of multiple trauma patients were reported to have injury to the airway at any level. Stabilize the airway first. Immediate surgical airway procedure can be necessary in less familiar circumstances and environments. If possible, define landmarks before the procedure. Defining anatomical zones is useful in penetrating injuries, although these do not guide diagnostic or therapeutic management completely. In unstable patients, elective surgical exploration is recommended instead of extensive diagnostic work-up. Unstable patients still need immediate exploration, whereas all stable patients will first be assessed with clinical examination and CT angiography and fibreoptic laryngoscopy. Thus the take home message is to consider all neck injuries an emergency and proceed with the diagnosis and management without delay.

Pain in the neck: Bench press injury.

A 49-year-old man with a history of hepatitis C infection presented to the emergency department with neck pain and hoarseness immediately after a blunt neck injury. He was bench pressing a 100 kg barbell when the safety bar broke. The bar slowly landed on his neck and remained there for a few seconds. On examination, his vital signs were normal except for hypertension, 167/106 mm Hg. His neck was tender to palpation, without swelling or ecchymosis. He had hoarseness, but the airway was patent without stridor. He showed no signs of respiratory distress. Computed tomography (CT) scan showed thyroid cartilage fracture and right arytenoid hematoma (Figure 1). Flexible fiberoptic laryngoscopy performed in the emergency department confirmed a right arytenoid hematoma with intact airway (Figure 2). Platelet count and prothrombin time-international normalized ratio were normal. Due to concerns of an impending airway emergency from the hematoma, he stayed in the observation unit for 12 hours. A second fiberoptic laryngoscopy on the next day showed no enlargement of the hematoma. He was discharged with close follow-up and recovered without any adverse events. Blunt laryngeal trauma is a rare but potentially life-threatening condition often caused by motor vehicle collisions, sport-related injuries, physical assaults, and strangulation. Clinically, it can cause neck pain, hoarseness, dyspnea, stridor, ecchymosis, crepitus, and airway obstruction.1 The first step in management is to assess and, if necessary, secure the airway. CT scan and flexible fiberoptic laryngoscopy are the key diagnostic tests for suspected laryngeal injury.2 A high index of suspicion and judicious use of diagnostic modalities are required as some patients with significant injuries may not have obvious signs of trauma, as in this case. Patients with high-grade injuries may require surgical intervention.3 Early intervention is the key to a good functional outcome.4

Usefulness of Magnetic Resonance Imaging for Diagnosing Os Odontoideum

A 75-year-old woman fell down after tripping over a step and suffered blunt face, neck and left shoulder injuries. On arrival, she had clear consciousness, tachycardia, tachypnea, posterior neck tenderness, left shoulder motion pain without motor or sensory disturbance at each extremity, and contused wounds at the forehead, nasion, upper lip, and left leg. Computed tomography (CT) showed congenital fusion of C3 and C4 (Klippel Feil syndrome) and separation of the dens body, which was initially diagnosed as acute dens fracture. Subsequent magnetic resonance imaging (MRI) showed dens body bruising and soft tissue injuries around the cervical spine. However, there was no sign of injury at the junction of the separated dens. She received a diagnosis of congenital os odontoideum without instability. She was treated with only a soft collar and pain killers and discharged on foot on day 10. To manage a patient with os odontoideum and blunt neck trauma, MRI is necessary to make a correct diagnosis, identify associated injuries and provide appropriate treatment.

Neurogenic Pulmonary Edema following Carotid Intervention: A Rare Case Report

Abstract Extracranial carotid artery aneurysms are rare complication of atherosclerotic degeneration or traumatic neck injury and are managed with interventional and open surgical approaches with variable results. In cases with technical difficulties rarely managed with parent artery embolization. We present a case of a 50-year-old male with prior history of blunt neck injury during road traffic accident and presented with left-sided neck swelling 8 years after injury, diagnosed with internal carotid artery pseudoaneurysm, managed with parent artery embolization, 3 days later presented with hemiplegia and sudden respiratory distress, evaluated and diagnosed as massive cerebral infarct and acute pulmonary edema, managed with ventilator support and improved clinically within 48 hours, extubated. However patient developed sepsis during the hospital stay and succumbed to disease after 20 days. We present this case in view of rare presentation of neurogenic pulmonary edema following carotid intervention.

Incidence of Blunt Brain and Neck Injury by Blast in Colombian Military Personnel: A Cases Review

General Objective: To describe the incidence of blunt trauma/injury accidents and injuries caused by unconventional weapons in military personnel of the Colombian National Army in a period from 2017-2021. Specific Objectives: 1. To characterize mortality per year of injuries due to accidents and/or unconventional weapons in the military personnel 2. To describe per year the number of cases attended at the Central Military Hospital of Nueva Granada. 3. To contextualize about blunt Injury and the experience of military engineers of the Colombian National Army in explosive devices. Methodology: Retrospective systematic review of cases, 704 case histories were reviewed considering clinical and imaging variables for the diagnosis of blunt injury and a descriptive analysis was performed. Results: The incidence of blunt injury in our study was like that reported at the international level. The study yielded a result of 1.65% incidence, a figure within the international range (0.03 to 4.8%) of reported incidence. Conclusion: It is important the multi and interdisciplinary management for this pathology, all hospitals, and national clinics, should be prepared for the diagnostic suspicion and approach of Blunt Injury, it is a clinical condition with low incidence but with high impact on morbidity and mortality.

Traumatic rupture of the circle of Willis with closed head injury: Its pathology and possible pathogenesis

Massive and fatal subarachnoid hemorrhage (SAH) with an injury on the circle of Willis may be caused by blunt force to the head; however, it is extremely rare, and the precise mechanism of arterial rupture remains unclear. We investigated the clinicopathologic appearance of four rare autopsy cases of massive SAH associated with the rupture of the circle of Willis. All four cases were men aged 17–75 years who presented with a loss of consciousness within a short interval after the injury. Autopsy revealed that the rupture site was located in the vertebral artery in two cases and in the anterior cerebral artery (ACA) in two cases. During our literature review, we found no previous report on traumatic ACA rupture. Based on the correlation of the autopsy findings and the circumstance of injury, we determined that the accidental excessive stretching of the selected artery by neck anteflexion or rotation after a blunt trauma to the posterior head might have caused this rare lethal injury. These cases demonstrated the diversity of the traumatic rupture site of the circle of Willis after a blunt head and/or neck injury. The topographical features of the circle of Willis, particularly in correlation with the surrounding tissue, might account for the occurrence and site of these rare injuries.

Blunt Versus Penetrating Neck Trauma: A Retrospective Cohort Study.

Despite being common, neck injuries have received relatively little attention for important quality of care metrics. This study sought to determine the association between blunt and penetrating neck injuries on mortality and length of stay, and to identify additional patient and hospital-level characteristics that impact these outcomes. Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program database. Adult patients (≥18) who sustained traumatic injuries involving the soft tissues of the neck between 2012 and 2016 were eligible. Multiple imputation was used to account for missing data. Logistic regression and negative binomial models were used to analyze 1) in-hospital mortality and 2) length of stay respectively while adjusting for potential confounders and accounting for clustering at the hospital level. In a cohort of 20,285 patients, the crude mortality rate was lower in those sustaining blunt neck injuries compared to penetrating injuries (4.9% vs. 6.0%, P < .01), while length of hospital stay was similar (median 9.9 vs. 10.2, P = 0.06). In adjusted analysis, blunt neck injuries were associated with a reduced odds of mortality during hospital admission (odds ratio: 0.66, 95% confidence intervals [0.564, 0.788]), as well as significant reductions in length of stay (rate ratio: 0.92, 95% confidence intervals [0.880, 0.954]). Blunt neck injuries are associated with lower mortality and length of stay compared to penetrating injuries. Areas of future study have been identified, including elucidation of processes of care in specific organs of injury. Level 3 Laryngoscope, 131:E1109-E1116, 2021.

An Update in Imaging of Blunt Vascular Neck Injury.

Traumatic injuries of the cervical carotid and vertebral arteries, collectively referred to as blunt cerebrovascular injury (BCVI), can result in significant patient morbidity and mortality, with one of the most feared outcomes being cerebrovascular ischemia. Systematic imaging-guided screening for BCVI aims for early detection to guide timely management. In particular, accurate detection of the severity and grade of BCVI is paramount in guiding initial management. Furthermore, follow-up imaging is required to decide the duration of antithrombotic therapy. In this article, classification of the grades of BCVI and associated imaging findings will be outlined and diagnostic pitfalls and mimickers that can confound diagnosis will be described. In addition, updates to existing screening guidelines and recent efforts of criteria modification to improve detection of BCVI cases will be reviewed. The advent of postprocessing tools applied to conventional computed tomography (CT) angiograms and new diagnostic tools in dual energy CT for improved detection will also be discussed.

Laryngotracheal Separation Following Blunt Neck Injury

Blunt laryngotracheal injuries are rare. The signs and symptoms of blunt laryngotracheal trauma are not always specific to the extent or type of injury. A high index of suspicion should exist in any injury that may be associated with airway trauma. We report a 30-years man who had progressive shortness of breath following blunt neck injury. He had massive emphysema whereby an emergency tracheostomy with multiple fasciotomy was performed. During emergency tracheostomy, it was noted that he had anterior cricotracheal separation which was communicated posteriorly by mucosa and trachealis muscle.&#x0D; Bangladesh J Otorhinolaryngol; October 2016; 22(2): 114-118

The efficacy of the "no zone" approach for the assessment of traumatic neck injury: a case-control study.

PurposeRecently, several studies have demonstrated symptom-based, non-zonal algorithms for approaching penetrating neck injuries. The purpose of this study was to confirm the effectiveness of the “no zone” approach in traumatic neck injuries.MethodsMedical charts of patients with traumatic neck injuries who presented at the Regional Trauma Center in South Korea between January 2014 and December 2018 were retrospectively reviewed. Negative final neck findings (FNFs) were compared with positive FNFs (which include major vascular, aerodigestive, nerve, endocrine gland, cartilage, or hyoid bone injuries) using multivariate logistic regression analysis including values of the “zone” and/or no zone approach.ResultsOut of 168 trauma patients, 70 patients with a minor injury and 7 patients under the age of 18 years were excluded. Of the remaining 91 patients, 74 (81.3%) had penetrating neck injuries and 17 (18.7%) had blunt neck injuries. Initial diagnosis most frequently revealed external wounds in zone II (84.6%). Twenty (22.0%) and 36 (39.5%) patients had hard and soft signs, respectively, using the no zone approach. Further, there was a significant difference between the negative and positive FNFs in patients with hard signs (11.6% vs. 54.5%; P < 0.01, respectively). According to the multivariate logistic regression analysis, the hard signs were associated with an odds ratio (OR) for FNFs (OR, 18.92; 95% confidence interval, 3.55–157.60).ConclusionTraumatic neck injuries classified as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.

Neck trauma complicated by thyroid damage and pleural hematoma - literature review and personal case

Damage to the thyroid due to blunt neck injury is rare. About half of the described cases occurred in the thyroid with pathological changes. They are usually associated with large hematomas of the neck that cause respiratory failure. We present a case of a patient whose thyroid injury caused rupture of the left thyroid lobe with a hematoma of the mediastinum and right pleural cavity.

Neck Injuries: a Complex Problem in the Deployed Environment

Evaluation and treatment of injuries to the neck has received a lot of attention over the past 20 years. New evaluation protocols and treatment recommendations have been developed. The goal of this review is to examine these strategies and evaluate their suitability for treatment of patients in a deployed setting. Studies from several large trauma centers have changed common practice with regard to both penetrating and blunt neck injuries. The requirement to explore all zone II neck injuries has largely been replaced by a selective exploration based on physical examination and imaging. Also, blunt cerebrovascular injuries, once thought to be rare, have been demonstrated to be common and treatment dramatically reduces the morbidity and mortality. Injuries to the neck are a significant problem in the deployed environment. The blast injuries that are common in Iraq and Afghanistan produce multiple injured casualties. In addition to injuries to other body regions, injuries to the neck can involve both blunt and penetrating mechanisms as well as injuries to the spinal column. The extent and outcome of these complex injuries has not been fully evaluated and would remain an area worthy of study.

Delayed Stroke following Blunt Neck Trauma: A Case Illustration with Recommendations for Diagnosis and Treatment

Blunt cerebrovascular injury (BCVI) to the carotid artery is a relatively rare injury that is difficult to identify even with imaging. Any symptoms or neurological deficits following blunt neck injury mandate evaluation and consideration of BCVI. In an effort to highlight this issue, we report the case of a 31-year-old male patient who presented with left-sided weakness consistent with transient ischemic attack (TIA) and concussion. The patient's symptoms occurred within 24 hours of a blunt neck injury sustained by a knee strike during a basketball game. An initial computerized tomography (CT) scan of the brain was normal; a CT angiogram (CTA) of the neck and carotids did not reveal obstruction, dissection, stenosis, or abnormalities of the carotid or vertebral vessels and the patient was subsequently discharged. A magnetic resonance imaging (MRI) of the brain obtained four days after the initial injury demonstrated an acute infarct in the right middle cerebral artery (MCA) territory. Thus, despite initial negative imaging, neurological deficits must be aggressively pursued in order to prevent stroke in BCVI cases.

Vigilance in detecting traumatic blunt neck injuries: A case report

Vigilance in detecting traumatic blunt neck injuries: A case report

Pneumomediastinum following blunt trauma: Worth an exhaustive workup?

Incidental pneumomediastinum is a common radiologic finding following blunt thoracic injury; however, the clinical significance of pneumomediastinum on screening imaging is poorly defined (Curr Probl Surg. 2004;41(3):211-380; Injury. 2010;41(1):40-43). The purpose of this study was to define the incidence of aerodigestive injuries in patients with pneumomediastinum after blunt thoracic and neck injury. After institutional review board approval was obtained, a retrospective review was performed of all patients admitted to Los Angeles County + University of Southern California Medical Center with blunt neck and/or thoracic injuries between January 2007 and December 2012. All patients with pneumomediastinum on radiologic investigation were included. Data accrued included demographics, admission clinical data, injury severity patterns, incidence of aerodigestive injuries, operative findings, morbidity, mortality, as well as intensive care unit and hospital lengths of stay. A total of 9,946 patients were included in the study. The predominant mechanism was motor vehicle collision (49%), disproportionately male (76%). Overall, 258 patients (2.6%) had a pneumomediastinum: 65 (25%) and 193 (75%) were diagnosed on a chest x-ray or on a computed tomography (CT) scan, respectively. A total of 21 patients (8.1%) had an aerodigestive workup with bronchoscopy, esophagram, and/or esophagoscopy. Overall, four aerodigestive lesions (1.6%) were diagnosed. Three tracheobronchial injuries were identified on CT scan, and one esophageal injury was diagnosed on an esophagram. Two tracheobronchial injuries required surgery, while the remaining cases were managed nonoperatively. The overall mortality in this cohort was 10.9%. Isolated findings of pneumomediastinum on screening chest x-ray or CT following blunt trauma is a poor predictor of an aerodigestive injury. Highly selective workup in this clinical setting is warranted. Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Imaging of Blunt Vascular Neck Injuries: A Clinical Perspective

We will review the common injuries and anatomic distributions of blunt cerebrovascular injuries (BCVIs) of the neck, explain the grading criteria, and discuss the corresponding management. Artifacts associated with BCVI on CT will also be examined. Identifying common injury patterns and anatomic distributions associated with BCVI can help decide the grade and management earlier and reduce the risk for potential complications. Recognizing the common artifacts associated with BCVI helps the reader successfully recognize a true BCVI.

Imaging of Blunt Vascular Neck Injuries: A Review of Screening and Imaging Modalities

We will review the epidemiology of blunt cerebrovascular injuries (BCVIs) and the rationale for screening. Current imaging modalities used to screen for BCVIs will be discussed with an emphasis on CT angiography. Screening for BCVIs can decrease rates of postinjury complications, such as stroke. The use of standardized screening criteria and the appropriate imaging modalities can allow early detection of BCVIs and effective intervention.

Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury?

Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools. This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans. A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90% in predicting UCAI and LCAI when combining these two parameters. This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.

Phrenic nerve injury and diaphragmatic paralysis following pacemaker pulse generator replacement

Diaphragmatic paralysis (DP) is a common condition. It can be unilateral or bilateral and the diagnosis is usually based on a clinical and radiological findings. Bilateral diaphragmatic paralysis is usually symptomatic with dyspnea and acute respiratory failure while unilateral diaphragmatic paralysis is typically asymptomatic and when present, symptoms usually depend on the presence of underlying pulmonary or neurologic disease. DP can be the result of various chest conditions that affect the phrenic nerve such as tumors, vascular abnormalities or traumatic incidents during surgery as well as blunt or penetrating chest or neck injuries. We report a unique case of phrenic nerve injury and unilateral diaphragmatic paralysis secondary to pacemaker pulse generator replacement that was successfully treated with diaphragmatic plication.

Phrenic Nerve Injury and Diaphragmatic Paralysis Following Pacemaker Pulse Generator Replacement

Diaphragmatic paralysis (DP) is a common condition. It can be unilateral or bilateral and the diagnosis is usually based on a clinical and radiological findings. Bilateral diaphragmatic paralysis is usually symptomatic with dyspnea and acute respiratory failure while unilateral diaphragmatic paralysis is typically asymptomatic and when present, symptoms usually depend on the presence of underlying pulmonary or neurologic disease. DP can be the result of various chest conditions that affect the phrenic nerve such as tumors, vascular abnormalities or traumatic incidents during surgery as well as blunt or penetrating chest or neck injuries. We report a unique case of phrenic nerve injury and unilateral diaphragmatic paralysis secondary to pacemaker pulse generator replacement that was successfully treated with diaphragmatic plication.