Penetrating Neck Injuries Research Articles

Challenges in Managing a Case of Penetrating Neck Injury Complicated with Vascular Injury and Unrevealed Retained Foreign Body

Challenges in Managing a Case of Penetrating Neck Injury Complicated with Vascular Injury and Unrevealed Retained Foreign Body

Extended Prophylactic Antibiotics in Penetrating Neck Aerodigestive Injuries Are Not Associated with Improved Outcomes.

Background: Literature currently supports the limited use of prophylactic antibiotics within the trauma population. However, data supporting limited (≤24 h) or extended (>24 h) use in penetrating aerodigestive neck injuries is lacking. We sought to describe the role of prophylactic antibiotics in this population and hypothesized there was no reduction in complications for patients on extended prophylactic antibiotics. Methods: Using a single-center trauma registry, patients with penetrating aerodigestive neck injuries were identified over a 5-year period. Demographics, injuries, management, and prophylactic antibiotic utilization were collected. Patients were stratified by the utilization of extended prophylactic antibiotics. Outcomes included infection, leak, reinterventions, and mortality. Results: Of 436 patients with penetrating neck injuries, 72 (17%) patients were identified with aerodigestive injuries. Forty-one (57%) patients received extended (>24 h) prophylactic antibiotics, whereas 31 (43%) received limited (≤24 h) prophylactic antibiotics. There was no difference in the patient demographics or injury severity score between the two groups. Extended prophylactic antibiotic use was associated with higher rates of infection (22% vs. 3%, p = 0.036) and leak (15% vs. 0%, p = 0.034) and no difference in reintervention (20% vs. 3%, p = 0.068) or mortality (10% vs. 13%, p = 0.719) compared with limited prophylactic antibiotics. Median duration of extended antibiotic use was 7 days. Operative intervention was equivalent across extended prophylactic antibiotics and limited antibiotics groups (59% vs. 58%, p = 0.968). Conclusions: There is insufficient evidence to support the extended (>24 h) use of prophylactic antibiotics in patients with penetrating neck aerodigestive injuries.

Penetrating neck trauma” - Enigma to surgeons: A case report with review of literature

: We report for the first time a case of penetrating injury to carotid artery by a stone piece during welding using hammer.: A 26, year old male labourer presented with a penetrating neck injury by a stone piece. As the patient was stable, NCCT neck was done which revealed a metallic foreign body obliterating the right carotid space. CT Angiography was also done to rule out any vascular injury. The patient underwent neck exploration during which foreign body was removed and right carotid artery repair was done with 4-0 prolene. : The patient had no complications and showed no sequalae from this injury during follow up.: CT angiography should be done in all patients who are stable to rule out injury to great vessels before neck exploration .

ThP7.12 - Penetrating Neck Injuries as a form of deliberate self-harm: A Pre and Post COVID-19 Comparison

Abstract Introduction In March 2020, the UK government implemented the first national lockdown to contain the spread of COVID-19. Despite success at curbing infection rates, early studies suggested a rise mental health issues, including an increased incidence of violent self-harm. This included penetrating neck injuries. Limited research is available on the pandemic’s effect on self-harm in the UK. Methods Data was collected from self-harm major trauma activations to a regional trauma centre, between 01/01/17 to 31/12/22. All patients identified with neck-related self-harm injuries were included. Demographic information and injury data was grouped for analysis into pre-COVID-19 (2017-19), and post-COVID-19 outbreak (2020-22) groups. Results Penetrating neck injuries due to self-harm, post-2019, increased fourfold (12 vs 47). Men were the majority in both periods, but women had a larger proportional increase (men 10 vs 34, women 2 vs 13). Mean ages of Men presenting increased (Men 44 vs 53, Women 36 vs 35) Conclusions The frequency of self-harm related neck injuries increased following lock down. Older men were most likely to present, however there was an associated rise in the number of women. We must further investigate the impact the pandemic had on the population’s mental health and tendency towards violent self-harm, particularly in older men.

Retrospective study of detecting oesophageal injuries post neck trauma: CTA versus fluoroscopy.

Timely detection of oesophageal injuries post-penetrating neck trauma is imperative because of the associated high morbidity and mortality. Patients commonly undergo both CT angiography (CTA) and contrast swallow studies (fluoroscopic oesophagography) when oesophageal injury is suspected. To determine the radiological findings of oesophageal injury after penetrating neck trauma comparing CTA and fluoroscopic oesophagography at a single tertiary centre. The study retrospectively reviewed the data from CTA and fluoroscopic oesophagography reports of patients suspected of oesophageal injuries secondary to penetrating neck trauma at a tertiary hospital in South Africa from January 2018 to December 2022. A total of 76 records were reviewed. The mean age for the participants was 31.5 years, ranging from 0.75-66 years. In this study 6/76 (8%) patients had confirmed oesophageal injury on fluoroscopy, which is considered the gold standard. The majority of penetrating neck injuries were in the 20-29 year age group, with 33/76 (43%) injuries. Stab wounds as the mechanism of injury accounted for 57/76 (75%). Dysphagia was experienced by 10/76 (13%) of those who had injuries. Zone I injuries accounted for 33/76 (43%) of the injuries. The incidence of oesophageal injuries secondary to penetrating neck injuries is comparable to previous studies. This study determined that CTA has a high sensitivity but low specificity. Fluoroscopic oesophagography should, therefore, be performed in patients who have an abnormal CTA coupled with clinical signs and symptoms of oesophageal injury.

Head and Neck Airbag Penetrating Injuries.

Airbags have significantly decreased fatalities in frontal vehicle accidents, but their deployment can lead to more severe injuries and rarely death. The authors present a case of a penetrating injury causing tissue loss in the left cheek, an "explosion" of the zygomatic arch, and facial nerve damage, discussing the management in the contest of literature examining similar injuries in the head and neck region. Reviewing English literature from 1995 to 2023, 9 patients experienced severe airbag-related penetrating head and neck injuries, in 3 cases resulting in death. In addition, we describe the case of a young male reporting a deep cheek laceration with facial nerve damage, tissue loss, and comminuted maxilla-zygomatic fracture; 48 hours after trauma, he underwent surgical reconstruction using a bilobed flap, direct suture of the resected masseter muscle, closed reduction of the comminuted zygomatic arch fracture, and direct neurorrhaphy of the lacerated facial nerve. Five months after surgery, facial nerve function recovery was observed. Mouth opening was restored, but a mixed low-medium hearing loss persisted for high frequencies. In another case marginal nerve damage was reported, but management is not described. The use of seat belts and airbags has led to a significant reduction in the incidence of facial fractures and fatalities after motor vehicle accidents, but at the same time, in some cases, complex facial trauma and/or penetrating injury can be observed. In case of suspected or certain facial nerve damage, it is mandatory to perform exploration and eventual reconstruction within 72 hours.

Rupture of the internal jugular vein and tension pneumothorax in a penetrating neck-lung injury due to iron splinters: a case report

Background: Penetrating neck injuries are relatively rare but pose significant challenges due to the concentration of vital structures in this area. This case report presents a unique in-stance of a 20-year-old male with a penetrating neck injury caused by iron splinters, resulting in the rupture of the internal jugular vein and tension pneumothorax.Case Presentation: The patient, a 20-year-old male, presented with restlessness, chest pain, rapid breathing, and a penetrating wound on the left side of the neck. Initial management included needle decompression for tension pneumothorax and radiological assessments to localize the foreign body. C-arm revealed that the foreign body had penetrated the upper left thoracic region and lung parenchyma. The surgical intervention involved repairing the internal jugular vein and performing pulmonary resection to remove the iron splinters.Conclusions: This case highlights the importance of a multidisciplinary approach in managing complex penetrating neck injuries. Advanced imaging techniques and timely surgical interventions are crucial for optimizing patient outcomes. Future research should focus on refining diagnostic protocols and exploring minimally invasive surgical techniques to improve the management of such injuries.

Pharyngocutaneous Fistula Following Traumatic Neck Injury: A First of its Kind.

Till date, a pharyngocutaneous fistula has been exclusively reported as a sequela of laryngo-pharyngectomy. We are reporting the first-of-its-kind case of pharyngocutaneous fistula following a penetrating neck injury. As conservative management failed, surgical repair was performed using a loco-regional muscular flap with complete success.

Directed work-up of select penetrating neck injuries is safe: Hard signs continue to soften

IntroductionManagement of penetrating neck injuries (PNIs) has evolved over time, more frequently relying on increased utilization of diagnostic imaging studies. Directed work-up with computed tomography imaging has resulted in increased use of angiography and decreased operative interventions. We sought to evaluate management strategies after directed work-up, hypothesizing increased use of non-operative therapeutic interventions and lower mortality after directed work-up. MethodsPatients with PNI from 2017 to 2022 were identified from a single-center trauma registry. Demographics, injuries, physical exam findings, diagnostic studies and interventions were collected. Patients were stratified by presence of hard signs and management strategy [directed work-up (DW) and immediate operative intervention (OR)] and compared. Outcomes included therapeutic non-operative intervention [endovascular stent, embolization, dual antiplatelet therapy (DAPT), or anticoagulation (AC)], non-therapeutic neck exploration, length of stay (LOS), and mortality. ResultsOf 436 patients with PNI, 143 (33%) patients had vascular and/or aerodigestive injuries. Of these, 115 (80%) patients underwent DW and 28 (20%) patients underwent OR. There were no differences in demographics or injury severity score between groups. Patients in the DW group were more likely to undergo vascular stent or embolization (p = 0.040) and had fewer non-therapeutic neck explorations (p = 0.0009), compared to the OR group. There were no differences in post-intervention stroke, leak, or mortality. Sixty percent of patients with vascular hard signs and 78% of patients with aerodigestive hard signs underwent DW. ConclusionsDirected work-up in select patients with PNI is associated with fewer non-therapeutic neck explorations. There was no difference in mortality. Selective use of endovascular management, AC and DAPT is safe.

Incidental Quiescent Metallic Foreign Body in a Case of Penetrating Neck Injury

Incidental Quiescent Metallic Foreign Body in a Case of Penetrating Neck Injury

Emergency surgery for penetrating neck trauma and common carotid artery laceration presenting with shock: a case report

Introduction: The neck is an important anatomical junction connecting the head and limbs to the trunk and several vital neurovascular and aerodigestive structures pass through it. Zone II is the commonest site of penetrating neck injuries (PNI) and is commonly associated with vascular injury. The mortality rate following PNI is approximately 10%, increasing to 20% with concomitant penetrating carotid injury. Case description: A 43-year-old was brough to the emergency department in class III haemorrhagic shock with a 5mm, bleeding, penetrating neck injury in zone II of the neck. He had soft signs of vascular injury, bleeding was controlled with direct pressure, and resuscitation was commenced with intravenous crystalloids and blood products. Surgical exploration revealed a 5mm laceration in the distal common carotid artery which was repaired primarily. Postoperative computed tomography (CT) angiogram was normal and the patient had an uneventful recovery. Discussion: Traumatic disruption of the platysma is described as PNI and accounts for 10% of all penetrating injuries. Vascular injuries are most commonly seen in zone II and are usually associated with hard and soft signs of vascular injury. Zone II injuries require operative exploration with preoperative CT angiography recommended in haemodynamically stable patients to identify the type of injury. Small defects in the carotid artery can be repaired primarily. Conclusions: Open surgical exploration is mandatory for all patients with penetrative neck injury and haemodynamic instability. CT angiogram is recommended prior to open exploration is stable patients with zone II PNI.

Pattern and Outcomes of Penetrating Neck Injuries in Warzones: A Cohort Study

Pattern and Outcomes of Penetrating Neck Injuries in Warzones: A Cohort Study

Penetrating Injury Neck Sparing Major Vital Structures: A Case Report

Introduction: Penetrating neck injury accounts for only a small incidence of all trauma case. The neck is a compact structure with vascular, neural and aerodigestive tract compacted closely.Trauma to the aerodigestive tract, neural structures, vascular structures can present with increased mortality and morbidity Case Presentation: The authors here report a peculiar case of 24 years old male presenting with Penetrating neck injury by a wooden foreign body. The patient was managed surgically without any related complications. The Foreign Body was found to be missing all the vital structures in the neck after thorough confirmation by imaging modalities and later intra-operative findings. Discussion: Due to the close vicinity of these structures, injury to vital structures is a very real and potentially life threatening complication. Associated vascular, Aerodigestive and neural injuries results in an increase in fatality rate up to 50% in some cases and may be associated with an increased risk of medianitis. Furthermore, wooden foreign body carries an increased risk of infectious, difficulty of detection in different imaging modalities. Foreign body neck is known for secondary displacement during neck movements, hence confirming that an early treatment is strongly recommended. Conclusion: Due to high risk of injury to vital structures and mortality prompt detection and management of penetrating injury neck should a high priority

A case of penetrating neck injury in zone II treated with combined endovascular and surgical management

AbstractBackgroundWe report a case of zone II penetrating neck trauma with active bleeding in which endovascular treatment was performed prior to neck exploration to identify and control the bleeding point.Case PresentationA man in his 50s presented to our emergency department in hemorrhagic shock stemming from a penetrating knife wound injury to the right side of his neck. He was bleeding massively from the right neck wound and oral cavity. Cervical angiography showed bleeding from the right external carotid artery and intimal injury to the right internal carotid artery. Balloon occlusion at the common carotid artery origin and distal to the injured internal carotid artery controlled active bleeding. During vascular balloon occlusion, definitive hemostatic treatment was achieved through ligation of the proximal external carotid artery.ConclusionNeck exploration combined with endovascular treatment may be one option as a treatment strategy for patients with zone II penetrating neck injury.

Open Surgical Retrieval of a Foreign Body in the Neck: A Case Report

Foreign body retention in the neck may be either traumatic or iatrogenic. Penetrating neck injuries with retained bodies are critical, as the neck serves as a passage for structures essential to life. Therefore, prompt detection and retrieval of the foreign body are paramount in preventing mortality. Here, authors present a case in which a successful surgical retrieval was performed without any postprocedural complications, despite the patient presenting relatively late after the injury. In this case report, a 23-year-old male labourer presented with a right-sided neck swelling two months after a workplace injury involving a shattered metal plate. Imaging confirmed a 15×5 mm hyperdense metallic object penetrating the sternocleidomastoid muscle. Successful open exploration extracted a 1.5 cm metallic shard at the C6 vertebral level, with no major vessel or airway damage. Postoperatively, the patient exhibited no movement restrictions, highlighting the atypical presentation of a retained metallic foreign body and the importance of timely intervention and comprehensive imaging for successful management.

Post-Traumatic Dissection of the Right Common Carotid Artery: A Case Report

Arterial injuries in neck trauma often result in serious consequences that can compromise the patient's vital prognosis. Artery dissection injuries are not uncommon in traumatic events in this region. The diagnosis is based on a combination of clinical signs and confirmed by imaging. The management of neck arterial injuries is now based on algorithms based on the patient's clinical presentation at admission. We report the case of a patient who suffered a penetrating neck injury and whose imaging confirmed a dissection of the common carotid artery with occlusion of the internal carotid artery and for whom surgery was indicated based on clinical and radiologic findings.

TRAUMATISME CERVICO-FACIAL PAR BARRE DE FER : A PROPOS DE DEUX CAS PEDIATRIQUES

objective: Head and neck trauma is common in ENT emergencies. The severity depends on the area of impact, the causal object and the injuries caused. We report two cases of head and neck trauma secondary to an iron bar caused by a playful accident.observation 1: 12-year-old boy received for penetrating neck wound with an iron bar, affecting sectors 2 and 3 with entry point at the left subdigastric region and exit point at the ipsilateral mastoid region. The exploratory cervicotomy did not find any major vascular lesions and allowed the extraction of the blunt object. The postoperative course was simple.observation 2: 8-year-old girl received for trauma to the mandible by a transfixing iron bar. The exploration revealed an iron bar which crossed the submental region with an exit point at the level of the floor of the mouth. The extraction was carried out without major vasculo-nervous lesions. The postoperative course was simple.Conclusion: Head and neck trauma remains a concern due to its potential seriousness and remains a medical-surgical emergency. The management of such a case must be preceded by a lesion diagnosis in order to prevent surgical surprises. Exploratory cervicotomy allows good exposure of the vascular-nervous structures. Prevention through parent education and child monitoring is essential to reduce the incidence of these injuries.

Profile of neck penetrating injury patients at Dr. Soetomo general hospital, Surabaya: A case series

Link of Video Abstract: https://youtu.be/Tk7yWllByJQ Background: Neck penetrating injuries are a life-threatening emergency. To date, one of the areas of ongoing controversy is whether all penetrating neck wounds in Zone II still require surgical exploration or whether patients can be managed non-operatively. An approach with absolute exploratory management for every penetrating neck wound results in a substantially reduced mortality rate. Case Description: We presented 5 cases of neck penetrating injury patients. In the first case, a 33-year-old man presented with a neck wound, hoarseness and subcuticular emphysema; the patient underwent colli exploration. In the second case, a 39-year-old man presented with multiple wounds in the neck, hematemesis and subcuticular emphysema; the patient underwent colli exploration. In the third case, a 27-year-old male patient presented with an 8 cm long open wound on the anterior colli, a visible rupture of cricoid and thyroid cartilage; the patient underwent tracheostomy and debridement. In a fourth case, a 37-year-old male patient presented with a 12 cm long sutured wound in the anterior colli, hoarseness, emphysema and air bubbling from the wound; the patient underwent colli exploration. In the fifth case, a 41-year-old male patient presented with a 7 cm long sutured wound at the anterior colli and a defect on thyroid cartilage; the patient underwent colli exploratory surgery. Conclusion: A hard sign was obtained in all five cases, and immediate colli exploration was performed without diagnostic supportive examination. The decision to perform surgery is now based on the presence or absence of "hard signs" of a penetrating neck wound.

Increased Incidence and Mortality of Civilian Penetrating Traumatic Brain Injury in Sweden: A Single-Center Registry-Based Study

Penetrating trauma to the head and neck has increased during the past decade in Sweden. The aim of this study was to characterize these injuries and evaluate the outcomes for patients treated at a tertiary trauma center. Swedish trauma registry data were extracted on patients with head and neck injuries admitted to Karolinska University Hospital (Stockholm, Sweden) between 2011 and 2019. Outcome information was extracted from hospital records, with the primary endpoints focusing on the physiological outcome measures and the secondary endpoints on the surgical and radiological outcomes. Of 1436 patients with penetrating trauma, 329 with penetrating head and neck injuries were identified. Of the 329 patients, 66 (20%) had suffered a gunshot wound (GSW), 240 (73%) a stab wound (SW), and 23 (7%) an injury from other trauma mechanisms (OTMs). The median age for the corresponding 3 groups of patients was 25, 33, and 21 years, respectively. Assault was the primary intent, with 54 patients experiencing GSWs (81.8%) and 158 SWs (65.8%). Patients with GSWs had more severe injuries, worse admission Glasgow coma scale, motor, scores, and a higher intubation rate at the injury site. Most GSW patients underwent major surgery (59.1%) as the initial procedure and were more likely to have intracranial hemorrhage (21.2%). The 30-day mortality was 45.5% (n= 30) for GSWs, 5.4% (n= 13) for SWs, and 0% (n= 0) for OTMs. There was an annual increase in the incidence and mortality for GSWs and SWs. Between 2011 and 2019, an increasing annual trend was found in the incidence and mortality from penetrating head and neck trauma in Stockholm, Sweden. GSW patients experienced more severe injuries and intracranial hemorrhage and underwent more surgical interventions compared with patients with SWs and OTMs.

The Evolution of Foreign Bodies Management in a Case of Near-fatal Penetrating Neck Injury.

Penetrating wounds of the neck with foreign bodies retention are frequent and often life-threatening events, and their management has changed in recent years from an open approach to a conservative approach thanks to the possibility of performing minimally invasive radiologically guided surgery. We present a case of penetrating glass injury to zone III of the neck in which the foreign body go through the parotid region passing near, but without injuring, the facial nerve and the external and internal carotid arteries.