Penetrating Neck Injuries Research Articles

Miraculous Escape in a Case of Penetrating Neck Injury by Arrow

Penetrating neck injuries due to arrowheads have become extremely rare in most of the nations. Although the basic principles of management remain the same as that of other penetrating injuries, certain extra precautions need to be taken while managing such cases. A 56-year-old man who suffered from an arrow injury to the neck had a lucky escape from any significant injury to vital structures. The patient underwent successful surgical removal of the arrowhead. Knowledge of the various principles of management of such injuries is key to a successful outcome.

Traumatic Common Carotid-jugular Fistula In A 6-year-old Child: Rare Cause Of Pulsatile Neck Mass

Background: Traumatic common carotid artery-jugular vein fistula is an uncommon clinical entity that may follow penetrating neck injury. It is rarely seen in children. It usually presents with a pulsatile neck mass following a history of trauma to the neck. It may present with pulsatile mass, thrill on palpation and murmurs on auscultation. There may be a neurologic deficit, which may vary from hemiparesis to hemiplegia. We present a case of traumatic arteriovenous fistula that presented as pulsatile anterior neck swelling in a school child. Case Presentation: A 6 year old male child, presented with a 3 days history of penetrating gunshot injury to the right side of the neck, as a result of accidental discharge from a gun during a marriage ceremony. The patient said to have bled profusely from the site of injury and had transient loss of consciousness. Examination revealed a healing wound and a slight swelling on the right side of the neck just anterior to the anterior border of the sternocleidomastoid muscle. The mass was pulsatile, with palpable thrill and bruit on auscultation. Colour doppler ultrasound demonstrated an abnormal connection with abnormal blood flow from the right common carotid artery to the right internal jugular vein. He was successfully treated surgically by neck exploration, excision of the fistula, and repair of defects in both vessels. Conclusions: Traumatic carotid-jugular fistula following gunshot injury is rarely seen in children. Guns should not be used or left unattended to in crowds so as to forestall future occurrence of accidental discharge that could lead to avoidable injuries. We recommended strict adherence to the rules and regulations guarding the use of firearms by civilians.

A Rare Case of Traumatic Thyroid Gland Hypoperfusion/Devascularization After a Gunshot Wound Through the Neck: Computed Tomography Findings

Patient: Male, 26-year-old Final Diagnosis: Hypoperfusion/devascularization of the thyroid gland Symptoms: Base of neck gunshot wound Medication:— Clinical Procedure: — Specialty: Radiology Objective: Rare disease Background:The thyroid gland is rarely injured in cases of penetrating neck trauma. Computed tomography (CT) plays a central role in prompt evaluation of the extent of penetrating neck trauma and can demonstrate thyroid gland injury. The current literature on thyroid gland injury is limited mostly to blunt trauma, with little emphasis on findings seen on CT imaging. In the present case report, we focus on CT imaging findings of thyroid gland hypoperfusion/devascularization in a patient who had a gunshot wound injury through the base of his neck.Case Report:A 26-year-old man was transferred to our trauma center after experiencing multiple gunshot wounds, including one through the base of the neck. The bullet path through his neck was associated with enlargement/edema involving the right thyroid lobe, with an asymmetric decrease in enhancement involving the mid and superior aspects of the right thyroid lobe. Maximum-intensity-projection angiographic images of the vascular supply of the thyroid gland suggested an abrupt decrease in caliber close to the origin of the posterior glandular branch of the right superior thyroid artery. The findings favored vasospasm rather than an arterial injury, which led to hypoperfusion/devascularization of the upper pole of the right thyroid lobe.Conclusions:Thyroid gland hypoperfusion/devascularization after a penetrating neck injury is rare. Recognition of CT imaging findings that favor post-traumatic organ hypoperfusion/devascularization is crucial for prompt management and to decrease morbidity in such cases.

クロスボウによる穿通性頸部損傷の救命例(A successful case of penetrating neck injury caused by a crossbow)

要旨穿通性頸部損傷は受傷機転の多くはナイフによる刺創や銃創である。今回我々は，極めて特殊なクロスボウによる貫通性頸部損傷の救命例を経験した。症例は40歳代の女性。何者かにクロスボウで頸部を撃たれて受傷し，矢が耳介直下を右側から左側にほぼ水平に貫くように頸部を貫通した。初期評価で気道や呼吸，循環動態の破綻を認めず，拡大する血腫などのハードサインも認められなかった。治療方針決定のためにcomputed tomography angiography（CTA）を撮像したところ，外頸動脈分枝に損傷による解離性動脈瘤が確認された。血管造影および透視下に矢を抜去する方針とし，全身麻酔下にまず外頸動脈損傷部に対してコイル塞栓術を行った。続いて，両側の総頸動脈近位側にバルンカテーテルを誘導して出血に備えてスタンバイし，透視下に適宜造影を行いながら矢を抜去した。抜去後は創部からほとんど出血は認めず，単純縫合閉鎖を行った。環椎前弓の骨折や顔面神経損傷に対する追加治療を要したが，創感染やその他の特筆すべき合併症を認めず，第21病日に退院となった。穿通性頸部損傷においては，受傷機転や成傷器の特性をよく理解し，ハードサインの有無により緊急度を判断すると同時に，CTAなどの画像診断を組み合わせて慎重に治療戦略を構築することが重要である。

Laryngotracheal and pharyngoesophageal traumatic injuries from US military operations in Iraq and Afghanistan, 2003–2017

IntroductionLaryngotracheal and pharyngo-oesophageal trauma present military providers with especially difficult, life-threatening challenges. Although effective treatment strategies are crucial, there is no clear consensus. This study of combat injuries from Iraq...

A survived case of penetrating neck injury with intrathoracic organ damage

BackgroundThoracic surgeons rarely encounter stab wounds with injury to the intrathoracic organs. However, such sudden and urgent situations could arise; therefore, experiences in managing such cases are invaluable.Case presentationAn 84-year-old woman with depression who had a stab injury in the neck caused by a broad-bladed kitchen knife was brought to our facility by ambulance. She was stable in the emergency room; however, a computed tomography scan revealed that the blade had penetrated the right thoracic cavity. A right hemopneumothorax was seen. Considering the possibility of injury to the major vessels, a median sternotomy was performed. During the dissection around the blade, the patient started bleeding profusely, which required repair of an injury to the right internal jugular vein. The blade tip had penetrated the dorsal right upper lung lobe; however, it did not reach the hilum, and the knife was carefully removed. The damaged area of the lung was removed by wedge resection.ConclusionPatients with deep stab wounds from knives are often hemodynamically stable because the blade acts as tamponade and prevents hemorrhage. Therefore, a surgical approach that allows for good visualization should be considered for the extraction of the blade.

How Can We Manage Penetrating Neck Injury with Blunt Carotid Injury and Spinal Injury: Case Report and Review of Literature.

The Neck is a cylindrical structure containing vital neurovascular and visceral structures tightly packed in a relatively small volume. Mortality rate increases when there is an injury to vascular structures especially the carotid artery, surrounded by other vital neurovascular structures; injuring the neck leads to devastating morbidity when compared to other injuries. With increased awareness of screening techniques and improved detection rates, there is an urge in opting for selective neck exploration and initial aggressive antithrombotic therapy for blunt carotid artery injuries. Here we report a case of a 20-year-old male, with a lacerated injury of the right side of the neck causing transection of the right internal jugular vein, grade 4 (Denver classification) blunt carotid injury, along with cervical vertebral fractures without neurological deficits. The patient underwent emergency surgical neck wound exploration, flush ligation of transacted Right Internal Jugular Vein, and conservative management for blunt carotid artery injury using anti platelets (Aspirin and Clopidogrel) avoiding any immediate neurological deficits. Whenever lacerated neck wounds are evaluated, the chance of blunt injury to the carotid is to be borne in mind and such an injury can be managed with double antiplatelet therapy, if there are no demonstrable neurological deficits.

A tailored protocol in management of penetrating neck injuries: experience at a level 1 trauma centre

Background: The management of penetrating neck injuries (PNIs) evolved markedly over last year’s towards more conservative approaches. Recent improvements in imaging modalities as multi-detector CT-angiography (MDCT-A) produced a paradigmatic shift towards 'no-zone' approach. In this study, we adopted a tailored protocol to deal with such injuries with less dependency on zone classification.Methods: This prospective study included patients with PNIs from February 2012 to January 2014. Unstable patients and patients with hard signs in zone-II were managed by immediate exploration. Patients with hard signs in zones-I and III had MDCT-A to check feasibility of endovascular intervention. However, all patients with soft signs and asymptomatic patients underwent MDCT-A regardless the zone affected to determine the need for therapeutic intervention. Complementary investigations were added in some cases with equivocal MDCT-A results.Results: Our study included 85 patients. Majority were males (94%; n=80) with mean age 27±4. Stabs were the main causative injury (51%; n=43). 63 (74%) patients were stable; with majority (64%; n=40/63) were symptomatic (18 presented with hard signs and 22 presented with soft signs). 53 (62%) patients had MDCT-A with sensitivity, specificity of 77%, 97% respectively and significant p value <0.05. After applying this protocol, we avoided 37% (31/85) non-therapeutic neck exploration, with only 4 (7.4%) negative cases on exploration. We experienced no missed injuries in the conservative group, yet 2 (3.7%) missed nerve injuries were encountered in intervention group.Conclusions: Zones-classification is losing popularity nowadays and shouldn't be the cornerstone of the new management protocols in PNIs. This selective tailored approach can be effectively used in management of PNIs. It avoids missed injuries and unnecessary explorations significantly.

'No zone' approach to the management of stable penetrating neck injuries: a systematic review.

Aim: to review outcomes of the 'no zone' approach to penetrating neck injuries (PNIs) with the advent of high-fidelity computed tomography-angiography (CT-A) in order to determine the most appropriate management for stable PNIs. Systematic review. Retrospective and prospective cohort studies of patients who sustained penetrating neck trauma, as defined by an injury which penetrates the platysma, and whose initial management involved CT-A evaluation. An extensive literature search was performed in July 2019 using the following databases: Pubmed Central, EMBASE, Medline and Cochrane CENTRAL. Only studies published in English from the last 15 years were included. Nine cohort studies met inclusion criteria. There has been an increase in CT-A focussed evaluation of PNIs in recent years. CT-A is a highly sensitive and specific imaging choice and reduces negative neck exploration rates. A new management algorithm for stable patients involving initial radiological assessment using CT-A, and subsequent selective surgical exploration, is safe and effective. The results of this review provide level 2A evidence that the 'no zone' approach to PNIs, complemented by CT-A and thorough clinical assessment, is a safe management strategy which reduces negative neck exploration rates.

A Case of Neck Injury Penetrating by Pieces of Glass to the Oral Cavity

All penetrating neck wounds are potentially dangerous and require emergency treatment, because there are important vessels, nerves, and organs in the neck. We report the rare case of a 71-year-old man with neck injury caused by a glass fragment that penetrated into the floor of the mouth from the submandibular region. The patient had accidentally fallen through a glass door and sustained a 15-cm long incised wound in his neck. He was initially transferred to a district hospital, where he was diagnosed as having arterial bleeding and a neck injury penetrating into the oral cavity; ENT surgeons at the hospital performed temporary hemostasis and tracheotomy under local anesthesia, and the patient was urgently transported to our hospital by ambulance. On admission, he was conscious, and his general condition was good. CT showed no damage to the major vessels, but revealed free air around the sublingual region. Therefore, emergency surgery was performed to repair the perforation from the neck into the oral cavity under general anesthesia. We found the facial artery and facial vein and ligated them during the operation, and the opening into the oral cavity was closed with absorbable sutures. The postoperative course was good, the patient resumed oral intake on day 4 after the surgery, and he was discharged from the hospital on day 9 after the surgery, with the only postoperative complication of palsy of the marginal mandibular branch of the facial nerve. In this report, we review nine cases of neck injury penetrating into the floor of the mouth and 11 cases of neck injury caused by a glass fragment reported in the literature and discuss their clinical findings.

Perioperative management of airway and neurogenic shock in patients with penetrating neck injury: A case report

Perioperative management of airway and neurogenic shock in patients with penetrating neck injury: A case report

An Audit of Surgical Neck Explorations for Penetrating Neck Injuries in Northwestern Nigeria: Experience from a Teaching Hospital.

Background:Penetrating neck injury is a major trauma mechanism present in about 5%–10% of trauma patients with an estimated mortality of 3%–10%. The management of these injuries is dependent on the anatomical level of injury.Objectives:The objective of the study was to document the clinical and operative findings as well as the treatment outcome among our patients who underwent neck exploration for penetrating neck injuries.Materials and Methods:A retrospective review of patients who had neck exploration for penetrating neck injury between January 2012 and December 2018 was done.Results:Thirty-five patients all of whom had surgical neck exploration were included. The age ranged from 15 to 62 years with a male: female of 7.8:1. The mean age was 30.7 years with standard deviation of ± 12.5 years and the peak age of occurrence of 20–29 years. The mechanism of injury was commonly arrow injury in 9 (25.7%) and suicidal cutthroat in 7 (20%) patients. Thirty-two (91.4%) patients presented with stable vital signs. Zone II neck injuries were most prevalent, seen in 23 (65.7%) patients. Laryngeal injury in 7 (20%) and soft-tissue injury in 7 (20%) of the patients were the most common intraoperative findings. The complication rate of 17.1% with a mortality rate of 2.9% was recorded. There was a statistically significant association between the presence of vascular injury and the development of complications after exploration (Chi-square = 5.666, P = 0.017). It was also a significant positive predictor of complication following neck exploration (odds ratio = 0.017, P = 0.048).Conclusion:Male young adults were most involved, commonly from arrow and stab injuries. Although laryngeal and soft-tissue injuries were predominant, vascular injuries were most associated with postoperative complications.

The management of penetrating neck injury at a level 1 trauma centre: three year's experience

Introduction: King's College Hospital serves an inner-city area with a high incidence of violent penetrating trauma. The OMFS team is involved in the management of penetrating injuries sustained to neck, and there is a standard operating procedure (SOP) in place for such cases.

Abcès cervical tardif sur plaie pénétrante par flèche : à propos d’une observation

Introduction. Les plaies pénétrantes du cou par flèche, quoique rares maintenant, peuvent être rencontrées dans certaines zones rurales de pays en développement, où l’accès aux soins hospitaliers demeure difficile. Observation. Nous rapportons le cas d’un patient congolais de 40 ans qui a consulté pour suppuration cervicale profonde, six mois après un traumatisme du cou par une flèche artisanale. L’exploration chirurgicale, après traitement antibiotique, a permis d’extraire le corps étranger vulnérant. L’évolution était favorable. Conclusion. Les plaies pénétrantes du cou par flèche artisanale nécessitent une prise en charge hospitalière précoce et adéquate par une équipe chirurgicale expérimentée afin d’éviter des suites compliquées voire désastreuses.

Penetrating Neck Injuries Treated at a U.S. Role 3 Medical Treatment Facility in Afghanistan During Operation Resolute Support.

Military trauma registries can identify broad epidemiological trends from neck wounds but cannot reliably demonstrate temporal casualty from clinical interventions or differentiate penetrating neck injuries (PNI) from those that do not breach platysma. All casualties presenting with a neck wound to a Role 3 Medical Treatment Facility in Afghanistan between January 1, 2016 and September 15, 2019 were retrospectively identified using the Emergency Room database. These were matched to records from the Operating Room database, and computed tomography (CT) scans reviewed to determine damage to the neck region. During this period, 78 casualties presented to the Emergency Room with a neck wound. Forty-one casualties underwent surgery for a neck wound, all of whom had a CT scan. Of these, 35/41 (85%) were deep to platysma (PNI). Casualties with PNI underwent neck exploration in 71% of casualties (25/35), with 8/25 (32%) having surgical exploration at Role 2 where CT is not present. Exploration was more likely in Zones 1 and 2 (8/10, 80% and 18/22, 82%, respectively) compared to Zone 3 (2/8, 25%). Hemodynamically unstable patients in Zones 1 and 2 generally underwent surgery before CT, confirming that the low threshold for exploration in such patients remains. Only 25% (2/8) of Zone 3 PNI were explored, with the high negative predictive value of CT angiography providing confidence that it was capable of excluding major injury in the majority of cases. No deaths from PNI that survived to treatment at Role 3 were identified, lending evidence to the current management protocols being utilized in Afghanistan.

The importance of anatomical zonal classification in the early management of penetrating neck injuries

Background: Penetrating neck injuries are common problem in our country due to increasing violence, terrorist bombing and military operations.These injuries are potentially life threating and need great attention and proper management.Objective: The aim of this study is to focus on the importance of anatomical zonal classification of the neck in the management of penetrating injuries of the visceral compartment of the Neck.Methods :70 patients with various injuries who were managed at causality unit and Otolaryngology department in Al-Kindy Teaching Hospital during aperiod from January 1st 2015 to October 31st 2015.The study carried on those patient depending on proper clinical examination and their urgent management.Results : Both civilian and military patients were admitted to the hospital, 34 patients (47.2%) in their 20s age group, while only 2 (2.8%) in 60s.High percentage of penetrating neck injuries in zone , 48 patient (68.6%) and lowest in zone , 6 patients (8.5%).40 patients (57.1%) presented with tracheal and laryngeal injuries and 12 patients (17.5%) were with pharyngeal injuries, 4 patients (5.7) were with recurrent laryngeal nerve injury and 13 patients (18.5%) presented with vascular injuries.Radiological examination done for 53 patients (75%) and we found foreign bodies in 30 patients (56.6%), tracheal deviation in 4 patients (7.5%) and emphysema in 19 patients (35.8%).Tracheostomy done in 51 patients (72.8%) neck, exploration in 20 patients (28.5%) and a 9 patients (12.8%) treated conservatively.Conclusion: Zonal classification of penetrating neck injuries was helpful in the management. Our study explains demographics and location of the injuries. Young men involved in violence and bombing was at high risk.Zone with involvement of trachea, larynx and pharynx were most common areas of injuries.RecommendationsAnatomical zone classification should be used as a guideline in management of penetrating neck injuries. (Trauma lifesaving guideline).Tracheostory should be practiced by every doctor in casualty unit. Team of surgeons and anaesthiologist should be always ready for any intervention with patient present to the casualty unite with a penetrating neck injury. Emergency medicine medical practice must be presents in every casualty unit to deal with insults.Aim of the study1.To recognize penetrating injuries of the neck according to the anatomic neck zones.2.Identify the outcome of their treatment

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.

Penetrating trauma during a global pandemic: Changing patterns in interpersonal violence, self-harm and domestic violence in the Covid-19 outbreak

IntroductionThe restrictions imposed on social activity in response to the Covid-19 pandemic have had a profound impact globally. In the UK, the NHS was placed on a war-footing, with elective surgery, face-to-face outpatient clinics, and community care facilities all scaled back as a temporary measure to redistribute scarce resources. There has been concern during this period over increasing levels of violence in the domestic setting, as well as self-harm. MethodsData was collected on all patients presenting with traumatic penetrating injuries during the ‘lockdown’ period of 23rd March to 29th April 2020. Demographics and injury details were compared with the same period in the two preceding years. ResultsOverall trauma fell by 35% compared with the previous year. Over one in four penetrating injuries seen were a result of self-harm, which was significantly higher than in previous years (11% in 2019, 2% in 2018). There were two cases of injuries due to domestic violence, while a total of 4 cases of injury arose in separate violent domestic incidents. Self-harm commonly involved penetrating injury to the neck. DiscussionOur centre has seen an increase in the proportion of penetrating injuries as a result of both self-harm and violence in the domestic setting. The number of penetrating neck injury cases, which can represent suicidal intent or a major presentation of psychiatric illness, is of particular concern. We must further investigate the effect of social restrictions on violent injury, and how home confinement may influence a changing demographic picture of victims.

Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach.

BackgroundMany current protocols for managing penetrating neck injuries (PNIs) still suggest zonal approaches. This study was undertaken to determine the correlation between the zone of the external wound and the level of the internal injury, and to verify whether a ‘no‐zone’ approach to PNI is valid.MethodsPatients admitted with a PNI to a tertiary trauma care centre between January 2011 and May 2018 were identified from a trauma database. Those with confirmed injury to the vascular system or an aerodigestive tract injury (ADTI) were included in the study. The medical records of each patient were reviewed with regard to the zone of the external wound and the level of internal injury, and the findings were compared.ResultsIn the period under review, 1075 patients were treated for a PNI. Of these, 298 (27·7 per cent) had a confirmed vascular injury or ADTI and were included in the cohort. In 176 patients (59·1 per cent) the site of the internal injury was in the same zone as the external wound. In a further 70 patients (23·5 per cent) there was no correlation between the site of the internal injury and the external wound, and in the remaining 52 patients (17·4 per cent) the correlation could not be determined. In this cohort, all clinically assessable patients with significant injuries had either physical signs suggestive of injury or deep surgical emphysema on radiological examination.ConclusionAn approach to PNI based on zones is questionable, and this study supports a no‐zone approach based on imaging guided by clinical examination.

Current Management of Penetrating Traumatic Cervical Vascular Injuries

Penetrating neck injuries constitute 5–10% of all emergency trauma presentations and are associated with a relatively high risk of mortality. The most common significant injury encountered in penetrating neck trauma is injury to the vasculature of the neck. This article reviews penetrating cervical vascular injuries, including initial assessment, immediate, and definitive management techniques. Assessment and management of penetrating injuries to the neck have traditionally been approached according to the location of the injury in relation to anatomic zones of the neck. More recently, due to advancements in imaging techniques and endovascular therapies, there is a trend towards non-operative management. This has resulted in a decrease in the rate of non-therapeutic surgeries. Penetrating traumatic cervical vascular injuries are potentially life-threatening and require appropriate clinical assessment to rapidly identify patients who need immediate surgical intervention. However, patients without hard signs of vascular injury should undergo imaging, most commonly in the form of computed tomographic angiography. For patients who require operative intervention, surgical techniques include vessel ligation, direct repair or angioplasty, interposition grafts, and damage control procedures. Endovascular techniques are particularly useful in the management of vascular injuries of the vertebral artery.