Blunt Neck Research Articles

Letter regarding "An overinflated, normal pressure endotracheal tube cuff sealed a tracheal defect in an 18-year-old man with blunt neck and chest trauma".

Letter regarding "An overinflated, normal pressure endotracheal tube cuff sealed a tracheal defect in an 18-year-old man with blunt neck and chest trauma".

Use of Triaging Algorithms to Decrease CT Use Following Blunt Head and Neck Trauma

Use of Triaging Algorithms to Decrease CT Use Following Blunt Head and Neck Trauma

The role of an overinflated endotracheal tube in the diagnosis of tracheal injuries

Tracheobronchial injury is an uncommon, but often life-threatening condition. It is mostly caused by blunt thoracic or neck trauma, difficult or prolonged intubation associated with nasogastric tube insertion. An early diagnosis and treatment can be lifesaver. The diagnosis is often late because of atypical symptoms and unspecific radiological signs, and due to the presence of severe coexistent injuries. Generally, the classic hallmark during physical examination is a progressive, extensive surgical emphysema. Radiological signs are often atypical, which makes the diagnosis more difficult. The most frequent signs found on computed tomography are also unspecific, mostly surgical emphysema, pneumomediastinum or pneumothorax may be noted. We present three patients suffering from airway laceration caused by car accident, difficult intubation, and prolonged utilization of nasogastric and endotracheal tube. All the patients had an overdistended endotracheal balloon herniated outside the extratracheal space along the rupture of the tracheal wall. These external balloons were all detected on radiography. This is a direct and pathognomic sign of airway injury, suggesting complete rupture in the tracheal wall. In our report, we would like to highlight the diagnostic role of an overinflated cuff. Orv Hetil. 2020; 161(25): 1063-1068.

Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa

BackgroundThe optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death.MethodsProspective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications.ResultsOne-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35–60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications (p = 0.074).ConclusionSurgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

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.

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.

Skull Base Fractures are Markers of Severe Forces in the First Two Years of Life

While experience indicates that basilar skull fractures are an uncommon injury in the first two years of life, an evidential basis for this observation is lacking in the forensic pathology literature. The aim of this study was to determine the incidence and forensic significance of basilar skull fractures in the first two years of life. This retrospective analysis reviewed pediatric deaths over a 17-year period in a large metropolitan medical examiner jurisdiction and included the deaths of infants and children under 24 months of age. All cases had a cause of death statement of “blunt head trauma”, “blunt head and neck trauma” or “blunt trauma”. Sixty-three cases were found, 23 of which had basilar skull fractures. The most common circumstance with basilar skull fracture was pedestrian versus motor vehicle accidents (57%), followed by inflicted injury (30%), and vehicle accidents in which the child was an occupant (13%). As such, basilar skull fractures are uncommon injuries that are the end result of the application of significant forces to the head. The discovery of a basilar skull fracture without an appropriate history of the accidental application of severe forces should cause those tasked with the investigation of child injuries and death to carefully consider inflicted head trauma.

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.

Internal Laryngocele and Zenker�s Diverticulum Masquerading as a Laryngeal Fracture and Esophageal Perforation and Rupture

Internal Laryngocele and Zenker’s Diverticulum Masquerading as a Laryngeal Fracture and Esophageal Perforation and Rupture We present an interesting case of concomitant laryngocele and Zenker’s diverticulum found incidentally after sustained blunt anterior neck trauma. Our service was consulted to evaluate free air on a CT scan in the paralaryngeal space and also the paraesophageal area of the cervical esophagus. The trauma surgery service had concern for laryngeal fracture and esophageal rupture. The patient’s lack of complaint except for a very stiff neck and failure to reveal abnormal findings on a complete head and neck exam, in addition to detecting no abnormal findings on flexible laryngoscopy, alluded that this air seen on the initial CT scan was not due to the injury. The formal CT scan of the larynx and trachea in addition to esophagram led us to a diagnosis of simultaneous laryngocele and Zenker’s diverticulum. This is a very unusual coincidental diagnosis; however it still raises the importance for maintaining a high level of suspicion and due diligence in assessing the upper aerodigestive tract in blunt anterior neck trauma.

Blunt Neck and Laryngeal Trauma Evaluation: An 11-Year Study

Introduction: Blunt neck and laryngeal trauma is rare. Since such injuries can be life threatening, their early management remarkably affects the immediate probability of patients’ survival and their long-term quality of life. Materials and Methods: In this retrospective and descriptive study, medical records of 54 patients with blunt neck and laryngeal trauma, who were referred to Imam Khomeini Hospital in Ahwaz over an 11-year period, were eval uat ed. T he col l ect ed dat a wer e t hen anal yzed b y descr i pt i ve st ati st i cal test s.

Our surgical approach to the patients with blunt and penetrating head and neck trauma and its evaluation

Our surgical approach to the patients with blunt and penetrating head and neck trauma and its evaluation

Delayed presentation of an isolated tracheal injury following direct blunt anterior neck trauma

Blunt injuries to the cervical trachea are rare but if present, are usually associated with either a direct impact the neck or acceleration—deceleration injuries. Patients with tracheal lacerations or ruptures tend to present acutely with signs of airway embarrassment. Such injuries are associated with concomitant injuries to the cervical structures. This particular type of injury thus presents a diagnostic and therapeutic challenge to emergency physicians, anaesthetists and surgeons alike. We present a case which is extremely rare in its clinical presentation. In addition, we propose a possible alternative way to manage a delayed anterior cervical trachea laceration.

A case of post traumatic retropharyngeal abscess

Retropharyngeal abscess following blunt trauma neck is rare. We report one such unusual case which was drained surgically.

Neurotrauma: The role of CT angiogram

Cerebrovascular injuries can occur in blunt or penetrating head and neck trauma. A high index of suspicion based on mechanism of injury and clinical assessment warrants screening for intracranial and extracranial vascular lesions. Conventional angiogram has been and remains the gold standard for diagnosis of these injuries, but computerized tomography angiography offers a fast, noninvasive method of imaging for neurotrauma patients. Advantages and disadvantages of each modality are discussed. [Neurol Res 2002; 24: S13-S16]

Reconstructive surgery for combined tracheo-esophageal injuries and their sequelae.

To evaluate surgical options of treatment in combined tracheo-esophageal injuries and their sequelae and elaborate new ones. The overlooked diagnosis of combined tracheo-esophageal injury would lead to severe stenosis of the esophagus and trachea with tracheo-esophageal fistula. This condition requires a complex surgical intervention to be performed with non-standard procedure in every single case. Forty patients with combined tracheo-esophageal injuries were treated in our institution. Nine patients were urgently operated while others were transferred to us from other hospitals with chronic sequelae of the initial trauma. In the majority of cases the cause of the injury was penetrating (17 patients) or iatrogenic (13 patients) trauma followed by blunt neck and chest trauma (six patients) and caustic burn (four patients). Three patients had total cut off of the esophagus and trachea, which were repaired with end-to-end anastomoses. Another six patients had tracheal and esophageal disruptions within one-half to three-quarters of circumference. In these cases both the trachea and esophagus were mobilized within wall laceration and sutured by interrupted Vicryl 4/0. One of them died due to pre-existing disease. Thirty-one patients with sequelae of the trauma were also operated on. In spite of the complexity and extent of the tracheo-esophageal stenosis and fistula the surgical treatment was aimed to one-stage reconstruction of both the esophagus and trachea. For this purpose we performed an originally developed surgical intervention, which was to be modified in accordance with patients diagnosis. The main point of the procedure is that after mobilization of the trachea and esophagus we resect an involved part of the trachea, but preserve a pedicled flap fashioned from the tracheal membrane. Then we remove the mucosa from the flap, resect an involved esophageal wall, repair esophageal mucosa and replace the defect of the muscular layer of the esophagus with the tracheal flap. Then a tracheal or laryngo-tracheal anastomosis is established. There were no postoperative mortality and complications among patients with the sequelae. Combined tracheo-esophageal injury requires the precise preoperative diagnosis and well organized plan of surgical treatment, which may be unique for every single patient. The main purpose of the treatment is to restore the continuity of both the esophagus and trachea in one-stage intervention.