Patterns and outcomes of traumatic neck injuries: A population-based observational study

Abstract

Objectives:We aimed to analyze the pattern and outcome of traumatic neck injury (TNI) in a small population.Materials and Methods:It is a retrospective analysis of all TNI patients who were admitted to the trauma center between 2008 and 2012. Patients’ demographics, details of TNI, associated injuries, hospital course, and mortality were analyzed.Results:A total of 51 TNI cases were included revealing an overall incidence of 0.61/100,000 population. The mean age was 31 ± 9 years. The most frequent mechanism of injury was motor vehicle crash (29.4%) followed by stab (17.6%), machinery injury (17.6%), fall (9.8%), and assault (7.8%). Larynx, thyroid gland, trachea, jugular veins, and carotid were the commonly injured structures. The majority of cases had Zone II TNI whereas isolated injury was observed in 11 cases. TNI were mainly presented with active bleeding (38%), hypovolemic shock (16%) and respiratory distress (16%). Surgical interventions mainly included simple repair and closure (53%), vein ligation (12%), repair of major arteries (4%), tracheal repair (6%), larynx and hypopharynx repair (4%), and repair of parotid gland (2%). Neck exploration was performed in 88%, and emergency tracheostomy was required in 18% of cases. Overall mortality rate was 11.8%, of which five patients had associated injuries, and one had isolated TNI.Conclusion:TNI are not frequent but represent an alarming serious entity in Qatar. Patients with persistent signs of major injuries should undergo early operative interventions. Moreover, the effective injury prevention program should be developed to minimize these preventable injuries in the majority of cases.

Penetrating neck injuries involving the larynx: A report of three cases

“…Patient 1 had injury to the epiglottic cartilage, patient2 had injuries to the thyroid and cricoid cartilages and patient 3 had injury tothe thyroid cartilage. Most surveys and case series indicate that zone II is the most commonly affected zone in pnis (1,4,8) and data from a large series of almost 2500 patients corroborate our findings that injury to the aerodigestive tract was often the most common, followed by the vascular system and then the nervous system in pnis. (10) However, some other studies indicate that vascular injury is the most common in pnis.…”

“…About 30% to 80% of patients with pnis have other injuries outside of the neck region. (1,2,4) COSECSA/ASEA Publication -East & Central African Journal of Surgery. March/April 2016 Volume 21 (1) in all trauma cases, management should follow the Advanced Trauma Life Support (ATLS) approach developed by the American College of Surgeons (12) with emphasis on ensuring a patent airway, adequate oxygenation and ventilation, and optimization of the blood circulation.…”

“…(16) Most pnis that were significant and required surgical exploration were symptomatic on presentation. (1)(2)(3)(4)11) Clinical findings are usually classified as "hard" or "soft" (8,11,15) Hard signs are indicative of major vascular or aerodigestive tract injury and include active bleeding, haemodynamic instability, expanding or pulsatile haematoma, bruit/thrill, pulse deficit, central neurologic deficit/evolving stroke, refractory shock, massive subcutaneous emphysema and significant airway compromise. Soft signs include venous oozing, nonexpanding or non-pulsatile haematoma, minor haemoptysis, dysphonia, dysphagia, air bubbling through wound, and mild emphysema.…”

“…Mortality rate for PNI in civilian populations range between 3-20 % with about 50% due to exsanguinating haemorrhage from vascular injuries. (3)(4)(5) Prompt and effective management is therefore essential.The optimal management of pnis however remainscontroversial. (6)(7)(8) We present 3 cases of PNI with associated laryngeal injuries and discuss the characteristics and challenges in their management especially in resource-constrained settings.…”