Stab wounds and lower-velocity GSW cause a 50% lower incidence of clinically significant lesions.īlunt neck trauma is even more uncommon than penetrating neck trauma. The major mechanisms are GSW, stab wounds, and shrapnel. The incidence of penetrating neck trauma is 0.55-5% of all traumatic injuries. However, Zone II injuries also have the best prognosis because there’s a larger areas of exposure, allowing for easier proximal and distal control. Zone II is the most exposed zone, and is consequently the most likely to be injured. Zones I and III are difficult to access and to manage in the operating room, with Zone I injuries at the highest risk. The struggle with neck trauma lies in the different zones of the neck. Zone III (upper neck) – above the angle of the mandible: distal carotid artery, vertebral artery, distal jugular vein, salivary/parotid glands, CNs 9-12 Zone II (mid-neck) – from the cricoid cartilage to the angle of the mandible: carotid/vertebral artery, larynx, trachea, esophagus, jugular vein, vagus and recurrent laryngeal nerves Zone I (base of neck) – below the cricoid cartilage (to the sternal notch): mediastinal structures, thoracic duct, proximal carotid artery, vertebral/subclavian artery, trachea, lung, esophagus The neck is divided into 3 Zones, which become important in evaluating and managing these patients, especially with regard to the structures lying within each division. Neck trauma can be split into penetrating injury and blunt injury. Oftentimes, the neck trauma patient may appear stable, only to have delayed injury found later, causing increased morbidity and mortality. Concern for vascular, neurologic, digestive tract, and airway injury are of paramount importance in the evaluation of these patients, as all can be life-threatening. The neck is a particularly tricky area of assessment and management in the trauma patient, as it is the location for many vital structures. Otherwise, surgical exploration is the intervention of choice.Author: Amaan Siddiqi, MD (Senior EM Resident, Brooklyn Hospital Center) // Edited by: Alex Koyfman, MD and Justin Bright, MD One study suggests that patients with stable, intimal, high zone 3 carotid injuries and vertebral artery injuries can be repaired endovascularly. While endovascular techniques have seen increasing use in other traumatic vascular injuries, open surgical repair is considered the gold standard for most vascular neck trauma. Zone 1 and 3 injuries are evaluated more selectively, particularly due to the difficulty in their surgical accessibility 4. Clinical criteria which would indicate surgical intervention/exploration include: One current study suggests that thorough clinical examination can prevent unnecessary surgical exploration of zone 2 neck injuries. Treatment of neck injury depends on the severity of injury and the zones of the neck which are involved. Previously, zone 2 injuries penetrating the platysma were thought to require immediate surgical exploration. ![]() ![]() Types of injury include vascular injury, esophageal perforation, laryngeal trauma and neurological injury. ~10% of injuries involve two zones 5.Īssessment of neck injuries has been aided by the use of CT angiography. important structures include the internal carotid artery, vertebral artery, external carotid artery, jugular veins, prevertebral venous plexus and facial nerve trunk.zone 3: from the angle of the mandible to base of skull.important structures include the common, internal and external carotid arteries, internal and external jugular veins, larynx, hypopharynx and proximal esophagus. ![]() zone 2: from the cricoid cartilage to the angle of the mandible.important structures include the aortic arch, proximal common carotid arteries, vertebral arteries, subclavian vessels, innominate vessels, lung apices, esophagus, trachea, brachial plexus and thoracic duct.zone 1: from the level of the clavicles and sternal notch to the cricoid cartilage.The neck has traditionally been divided into three anatomic zones when describing penetrating neck trauma, which guides clinical management 2: In one study, 11:1 ratio of males to females were identified in patients with penetrating neck injury 3. ![]() Young males are highly represented in patients with a traumatic neck injury.
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