Blunt Neck Trauma Research Articles

Asphyxialdeath due to fracture of thyroid cartilage, cricoid cartilage and arytenoid cartilage as result of blunt trauma of neck in a motorcycle accident:An Autopsy report

Laryngeal fracture is rare but fatal traumatic injury which is mainly caused by severe blunt trauma from interpersonal violence, motor vehicle accident or sports injuries. Laryngeal fracture can lead to severe airway collapse and death.Mortality decreases to less than 5% once the airways made patent and laryngeal injuries are corrected.People must take motorcycle riding safety course to learn how to ride safely. Always follow traffic rules. The motor vehicle accident can be prevented largely through public awareness and education

Isolated internal carotid artery dissection after a motorcycle accident: A case report

Extra cranial carotid artery dissection is one of the most important complications associated with blunt head and neck trauma. It is a major cause of ischemic stroke in young adults. We report a case of internal carotid artery dissection which caused transient hemiparesis, horizontal gaze to right and anisocoria in a 19-year-old male motorcyclist involved in a collision. Unenhanced brain computed tomography scan showed well defined infarction in the right frontotemporoparietal area. Digital subtraction angiography showed complete occlusion of the proximal cervical right internal carotid artery. Moreover, intimal dissection was observed in distal cervical left internal carotid artery which did not limit blood flow to the brain. A stent was placed at the site of dissection in the left internal carotid artery. Intravenous heparin was commenced to avoid further thrombosis. He was discharged home 40 days after the accident with oral anticoagulation. Extra cranial carotid artery dissection is a rare condition which may happen after a non-significant neck trauma. Accordingly, the diagnosis of a cervical vascular dissection requires strong clinical suspicion

A Case of Posterior Pharyngeal Wall Perforation After Blunt Neck Trauma

Perforation of the pharynx due to external blunt trauma is an uncommon type of pharyngeal injury. It can lead to serious complications such as deep neck infection, sepsis, mediastinitis, and even mortality if not promptly recognized and treated. Therefore, early diagnosis and treatment are crucial to prevent severe consequences and long-term complications. If the size of the injury is less than 2 cm and there is no invasion of the esophagus or mediastinum, conservative, nonsurgical treatment may be appropriate. In this case report, we present a case of retropharyngeal wall perforation following external blunt neck trauma with literature review.

Hyoid Bone Fracture Secondary to a Blunt Neck Trauma: A Report of 2 Cases.

Hyoid bone fracture unrelated to strangulation is a rare occurrence characterized by a subtle presentation. However, it may manifest as a fatal respiratory distress due to airway obstruction. We present 2 cases of hyoid bone fractures that occurred following a traffic accident in 2 male patients. Both patients presented with either a neck pain or a dysphagia. Physical examination findings were limited to neck sensibility at palpation, saliva stasis, and laryngeal congestion at the laryngeal endoscopy. In both patients, the diagnosis was confirmed through computed tomography. In the first patient, the fracture was simple and located at the body of the hyoid bone, while in the second patient, it involved the greater horn with a medial displacement of the fractured fragment. Due to the clinical presentation, we successfully treated both our patients conservatively through a 48 hour observation, analgesics, steroids, antibiotics, neck rest, and semiliquid diet. This study highlights a rare occurrence of 2 cases of hyoid bone fracture unrelated to strangulation, which emphasizes on the importance of a high clinical suspicion to make the diagnosis of this entity.

Hypopharyngeal Perforation Leading to Neck Emphysema and Pneumomediastinum: Case Report

Hypopharyngeal perforation due to blunt trauma in the neck is a very rare but potentially life-threatening condition. We present the imaging findings of a 16-year-old male who presented with dysphagia after blunt neck trauma from a baseball helmet. Less than twenty such cases have been reported in the world literature. No prior case has been published with associated pneumomediastinum.

Early Anticoagulation may prevent Stroke in Blunt Carotid Artery Injury

Blunt carotid artery injury (BCAI) is a rare sequelae of blunt neck trauma. It may lead to stroke and major neurological deficits. Therefore, early diagnosis and management are crucial to prevent or reduce associated morbidity. We report a 22-year-old male who sustained an accidental left BCAI with an air-gun bullet. The injury was suspected on clinical assessment and confirmed by a CT/angiogram of the neck. The patient was promptly started on therapeutic anticoagulation and did not develop any neurological deficits. Our case emphasizes the importance of non-invasive management of BCAI, which requires a high index of clinical suspicion for diagnosis. Once confirmed, starting therapeutic anticoagulation early is vital to avoid fatal consequences, namely strokes, in such patients. Keywords: Blunt injury; Carotid artery; Stroke; Anticoagulation; Vascular Trauma

Role of Ayurveda in rehabilitation of Abhighataja Pakshavadha - A Clinical Management

Traumatic cerebral haemorrhage is an increasingly recognized complication of severe blunt head or neck trauma, more common with patient with motor vehicle accidents, which may lead to complete paralysis, paraplegia, hemiplegia or severe conditions end up with coma. In the present case history, a 43 year aged male patient was in coma stage after he met with RTA and he recovered back with right hemiplegia. So, he was brought for Rehabilitation through Ayurvedic lines of management. Hence for the same, assessments were done through CNS examinations and NIH scoring was adopted to compare the effect before and after the treatment. And specific treatment was planned which includes Panchakarma, diet regimen, Physiotherapy, Shamanoushadhis and was successfully treated with Ayurveda interventions with reference to Pakshavadha line of management as a rehabilitative management and significant results were obtained after 3 follow ups (total duration for 112 days).

Abstract 018: External carotid artery Pseudo aneurysm induced Internal Carotid Artery compression causing acute ischemic stroke

Introduction Here, we describe a patient in whom ischemic stroke was caused by compression of the Internal Carotid Artery (ICA) by a Pseudoaneurysm (PSA) of the External Carotid Artery (ECA) after Gun Shot injury. Eventually, the PSA of the Internal maxillary artery (IMAX) was embolized, resulting in resolution of the patient's symptoms. Methods Case Report Results A 75‐year‐old male with a history of atrial fibrillation on Eliquis presented to the emergency department after sustaining a gunshot wound to the left face. He had extensive injuries through the left masticator and submandibular space with an inferior orbital wall fracture. A Computed Tomography Angiography (CTA) neck showed injuries to the left proximal IMAX with a small PSA. As the PSA was asymptomatic it was managed with observation. On HOD day 13, CTA was done for a brief period of unresponsiveness, which showed high‐grade narrowing of left cervical ICA due to extrinsic compression from PSA which was supplied by a branch of the left ECA with distal re‐constitution (image A). The next day, patient developed right sided plegia and aphasia with NIHSS of 17. A CT head showed no acute intracranial abnormality. The patient underwent emergent Digital Subtraction Angiography (DSA), which demonstrated occlusion of the left cervical ICA from compression from a left IMAX PSA which was treated with n‐butyl‐cyanoacrylate TRUFILL embolization with resolution of flow limitation in the left cervical ICA (Image B1,B2). After embolization, the patient was oriented and able to lift right arm and leg anti‐gravity. Magnetic Resonance Imaging (MRI) was contraindicated due to retained bullet fragments. Repeat CT head did not show stroke. Conclusion A Pseudo aneurysm is characterized by a rupture of the arterial wall and the formation of an aneurysmal sac by the adjacent structures while the sustaining artery remains intact. The most prevalent causes are penetrating or acute blunt neck trauma, hyperextension injury, and injury to the base of the skull (1). Predisposing factors for PSA include carotid endarterectomy or a late complication of carotid artery dissection, infection, radiotherapy, and malignancy (1‐2). Cox et al. reported 124 patients with significant neck and head penetrating injuries. Eleven patients were found to have thirteen head and neck PSA: two in the ICA, one in the vertebral artery, and ten involving branches of the ECA. Two of seven symptomatic PSAs manifested with episodes of massive hemorrhage (3). There have been case reports describing the consequences of an elongated styloid process causing an ischemic stroke due to subsequent dissection and PSA formation (4). According to our knowledge, this case report is one of the first to describe acute ischemic symptoms resulting from ECA PSA‐induced ICA compression, with resolution of symptoms following PSA embolization. The educational value of our case lies not only in the rarity of the condition but also in the uniqueness of its presentation. This case is a fundamental addition to the existing literature on rare neuro‐vascular anomalies leading to potential catastrophic outcomes.

Airway Obstruction with Blunt Neck Trauma from an Accidental High Tackle in Rugby.

Blunt neck trauma is an uncommon condition in sports yet life-threatening if left untreated; hence, early diagnosis and management is necessary once suspected. We report a collegiate rugby player tackled around the neck during intersquad scrimmage. He broke his cricoid and thyroid cartilage, resulting in cervical subcutaneous emphysema and pneumomediastinum and eventually, airway obstruction. Thus, he underwent cricothyroidotomy and emergency tracheotomy. After 20 d, the emphysema disappeared. However, dilation failure of the vocal cord remained, thereby requiring laryngeal reconstruction. In conclusion, blunt neck trauma can cause airway obstruction in various sports.

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.

Isolated comminuted fracture of the cricoid cartilage and narrowing of the airway after a traumatic blunt injury of the neck: a case report

BackgroundBlunt trauma to the anterior of the neck may compromise the vital structures like major blood vessels, trachea, larynx, pharynx, thyroid, spine, esophagus, and the cricoid. Laryngeal trauma is rare and accounts for 1% of all neck blunt traumas. Cricoid trauma is also very rare and accounts for half of the laryngeal traumas, and the diagnosis is frequently missed.Case presentationA 43-year-old man, with blunt neck trauma after being hardly hit by a crane lifting hook, was referred to the Shahid Beheshti Hospital. The patient complained of dysphonia (hoarseness) and dyspnea. The CT scans showed a comminuted fracture of the left anterior arch of the cricoid cartilage with left-sided mucosal thickening, inflammation, and edema which was extended to the glottis, causing a narrowing of the airway. Direct fiber-optic laryngoscopy revealed swelling and congestion in the epiglottis and swelling at the level of the left vocal cord.ConclusionThis case report highlights the conservative treatment of isolated cricoid cartilage fracture in the setting of low-energy blunt trauma. The patient was clinically stable and treated conservatively with oxygen therapy and silence therapy (complete silence).

Thyroid Rupture Secondary to Blunt Neck Trauma: A Case Report

Aim To discuss the clinical presentation of thyroid rupture following blunt neck trauma and highlight key management principles for the case. Methods A 45-year-old female motorcycle passenger with a pre-existing right thyroid nodule hit her right anterior neck against a bottle during sudden stop and developed painful right neck swelling, odynophagia, and hoarseness. She was seen at the emergency room 5 hours post-injury, awake, cooperative, and ambulatory, without stridor or dyspnea at room air. On examination, she had ecchymoses behind her right tonsillar pillars; her neck was grossly swollen and was tender on palpation without subcutaneous emphysema. Laryngoscopy showed good left vocal cord mobility while the right vocal cord had a visible hemorrhage and limited abduction due to the mass effect of the hematoma seen at the right aryepiglottic area extending toward the right piriform fossa and the right parapharyngeal area. Intact bilateral vocal cord adduction was noted upon phonation. Contrast-enhanced computed tomography revealed hematoma formation in the right thyroid lobe area with extension to the right side of the oropharyngeal region, anterior cervical, parapharyngeal, and retropharyngeal space, confirming the aerodigestive tract narrowing and leftward deviation previously noted. Baseline thyroid function tests were normal. Under general anesthesia, the patient underwent neck exploration where the ruptured right thyroid lobe was resected, and the hematoma was evacuated. Results Postoperatively noted significant improvement in neck swelling, odynophagia, and hoarseness. Transient subclinical hyperthyroidism remained asymptomatic and resolved upon outpatient follow-up. A year after the surgery, the patient had a well-healed cervical scar, complete hematoma resolution, and regained her pre-morbid phonation. Conclusion Thyroid gland rupture should be among the considerations for patients presenting with tender neck swelling, progressive hoarseness, and/or dyspnea following neck trauma. Prompt airway assessment and close monitoring for potential compromise are essential to avoid fatal sequelae of external airway compression. Management varies from close observation to surgical neck exploration and should be personalized depending on the severity of thyroid injury and symptomatology.

What is Key for Early Recognition of Major Upper Airway Disruption after Blunt Neck Trauma? - A Case of Cricotracheal Separation with Abnormal Neck Seesaw Movement

What is Key for Early Recognition of Major Upper Airway Disruption after Blunt Neck Trauma? - A Case of Cricotracheal Separation with Abnormal Neck Seesaw Movement

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".

An unusual case of surgical emphysema of neck due to compression injury: A case report

Neck trauma due to compressing injury (accompanied by surgical emphysema and pneumomediastinum) can be critical. It may develop in up to 10% of patients and may be a significant cause of morbidity and mortality due to the associated damage to the aerodigestive tract. Depending on the extent and severity of aerodigestive tract injury, management varies between conservative to surgical intervention. We present a case of blunt compressing neck trauma accompanied by subcutaneous emphysema secondary to compression of the neck by a cloth around the neck pulled by entangling in the shaft of a running electrical motor. It resulted in a leak in the oropharyngeal region which caused surgical emphysema in the cervicofacial region and pneumomediastinum. Its radiologic appearance, clinical presentation, and initial management options in the emergency department (ED) are presented here. Keywords: Blunt neck trauma, Pneumomediastinum, Subcutaneous emphysema electrical motor shaft.

An Adolescent with Transient Hyperthyroxinemia after Blunt Trauma to Head and Neck

Background Thyroid storm is a well-known complication of surgical procedures in the lower neck, but is rare after a blunt neck trauma. The cases described previously have mainly focussed on adults with pre-existent thyroid disease. In this case report, we describe the disease course of a previously healthy adolescent who had asymptomatic hyperthyroxinemia after a blunt trauma of the jaw and neck. Case Presentation. A 17-year-old girl presented at our emergency department after she fell on her head while roller blading. On physical examination, among other injuries, she had a swelling in the lower neck, which appeared to involve the thyroid gland. Subsequent laboratory analysis was indicative of primary hyperthyroxinemia, with a free T4 of 59 pmol/L (reference range: 12–22) and a TSH of 0.46 mU/L (reference range: 0.5–4.3), but the patient had no symptoms fitting with this. Four weeks after the initial presentation, the patient reported only complaints regarding tenderness in the jaw and neck region. She was no longer hyperthyroidic on biochemical evaluation (with a free T4 level of 15.6 pmol/L and a TSH level of 0.33 mU/L), and antibodies against thyroid peroxidase or TSH receptor were not present. Conclusions This case might indicate that hyperthyroxinemia following a neck trauma may go unnoticed if hyperthyroid symptoms are mild or absent and thyroid function tests are not performed.

Airway management of a patient with laryngotracheal disruption following blunt neck trauma.

Airway management of a patient with laryngotracheal disruption following blunt neck trauma.

A clinical case of successful treatment of complete abruption of the trachea from the larynx

Tracheobronchial injuries as a consequence of chest blunt trauma are rare. Blunt traumas of the cervical part of the trachea are a rarer pathology presenting a serious diagnostic problem for a clinician. Traumas of the larynx and the trachea account for 40 to 80% of lethality. The tracheas cervical part is vulnerable despite that it is covered with the neck muscles, spine, clavicles, and mandible. In cut/stab wounds, the tracheas cervical part is often damaged together with the adjacent structures. In blunt trauma, under a direct action of a traumatizing agent, the mobile trachea displaces toward the spine, accompanied by damage to the tracheal cartilages, its membranous part, and the soft surrounding tissues with preservation of the integrity of the skin.
 Tracheal ruptures along the distance up to 1 cm from the cricoid cartilage account for not more than 4% of all tracheal ruptures. A complete tracheal rupture and its abruption from the larynx are extremely rare pathology. Because of severe respiratory disorders, most victims die at the site where their injury occurred.
 This article presents a clinical case of the successful treatment of patient Z., 41 years of age, with complete tracheal abruption from the larynx. The cause of tracheal damage was blunt neck trauma in a traffic accident. A peculiarity of this clinical case was that the victim arrived at a specialized thoracic surgery unit with a functioning tracheostomy two days after the trauma.
 Conclusion. Tracheal trauma is a potentially fatal condition. Therefore, early diagnosis of tracheobronchial damage is essential since it permits timely surgical intervention and diminished risk of lethal outcome. When dealing with patients with trauma of the head, neck, and chest with non-corresponding clinical data and the absence of effective recommended standard therapeutic measures, a clinician should become alert and exclude the tracheal and bronchial damage.
 X-ray computed tomography and fibrotracheobronchoscopy are strongly recommended as reliable methods to diagnose tracheobronchial damages. In a surgical intervention, it is necessary to perform the primary suture on the trachea, avoid preventive tracheostomy, and delay interventions associated with poorer prognosis and a high complication rate.

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

Novel role of focused airway ultrasound in early airway assessment of suspected laryngeal trauma

BackgroundUpper airway injury secondary to blunt neck trauma can lead to upper airway obstruction and potentially cause a life-threatening condition. The most important aspect in the care of laryngeal trauma is to establish a secure airway. Focused airway ultrasound enables recognition of important upper airway structures, offers early opportunity to identify life-threatening upper airway injury, and allows assessment of the extent of injury. This information that can be obtained rapidly at the bedside has the potential to facilitate rapid intervention.Case presentationWe report a case series that illustrate the diagnostic value of focused airway ultrasound in the diagnosis of laryngeal trauma in patients presenting with blunt neck injury.ConclusionEarly recognition, appropriate triaging, accurate airway evaluation, and prompt management of such injuries are essential. In this case series, we introduce the potential role of focused airway ultrasound in suspected laryngeal trauma, and the correlation of these exam findings with that of computed tomography (CT) scanning, based on the Schaefer classification of laryngeal injury.