The management of penetrating neck injury

Weale, Ross; Madsen, Andre S.; Kong, V Y; Clarke, Damian

doi:10.1177/1460408618767703

Cited by 18 publications

(82 citation statements)

References 41 publications

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“…[ 12 ] While relatively uncommon in comparison to other mechanisms of injury, the potential morbidity of penetrating neck trauma is apparent, given the high density of vital structures confined to a relatively small and poorly protected area. [ 13 14 15 ]…”

Section: Introductionmentioning

confidence: 99%

An audit of surgical neck explorations for penetrating neck injuries in northwestern Nigeria: Experience from a teaching hospital

Ajiya¹,

Shuaibu²,

Anka³

2021

Niger J Surg

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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.

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Section: Introductionmentioning

confidence: 99%

An audit of surgical neck explorations for penetrating neck injuries in northwestern Nigeria: Experience from a teaching hospital

Ajiya¹,

Shuaibu²,

Anka³

2021

Niger J Surg

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“…This algorithm states that those with hard signs of injury should proceed directly to exploration, whilst those with soft signs of injury should undergo CT‐A, and only if positive, continue to the operating theatre. Some studies add that high impact mechanisms, such as gunshots, in asymptomatic patients should still undergo CT‐A 29 . Our review identified three studies 14,19,21 examining the ‘no zone’ approach, all of which demonstrated its safety with no complications or missed injuries in those conservatively managed.…”

Section: Discussionmentioning

confidence: 99%

‘No zone’ approach to the management of stable penetrating neck injuries: a systematic review

Chandrananth

Zhang

Voutier

et al. 2021

ANZ Journal of Surgery

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Background 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. Design: Systematic review. Population: 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. Methods 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. Results 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. Conclusion 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.

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“…However, damage to the pharyngeal, oesophageal, spinal cord and nerves are also very common. [ 2 ] Although this patient was incredibly fortunate that there was no life-threatening bleeding or tracheal rupture, he presented with phrenic nerve palsy, which resulted in DP.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the high concentration of vital structures in a small anatomic area, penetrating neck injuries are associated with substantial morbidity and mortality. [ 2 ] As a result, the Advanced Trauma Life Support guidelines recommend that vessels and airway injuries should be identified first during the early stages of the evaluation. However, damage to the pharyngeal, oesophageal, spinal cord and nerves are also very common.…”

Section: Discussionmentioning

confidence: 99%

Chronic respiratory dysfunction due to diaphragmatic paralysis following penetrating neck trauma

Wang

Liu

2021

Medicine

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Rationale: Respiratory dysfunction resulting from unilateral diaphragmatic paralysis during neck trauma is very rare in adults. We describe the symptoms, diagnosis and treatment of 1 patient with chronic respiratory insufficiency, in whom the diaphragmatic paralysis was associated with phrenic nerve injury due to penetrating neck trauma. Patient concerns: A 50-year-old worker was admitted because of left penetrating neck trauma. Imaging investigations demonstrated elevation of the left hemidiaphragm and the C5 and C6 roots avulsion. He complained of gradually worsening dyspnea on exertion 2 months later. Diagnoses: The patient was diagnosed with chronic respiratory dysfunction secondary to diaphragmatic paralysis, which caused by phrenic nerve injury. Interventions: A conventional video-assisted thoracoscopic diaphragm plication was performed after failed conservative management. Outcomes: The respiratory status improved markedly, and he did well without recurrence until 2 years’ follow-up. Lessons: The possibilities of phrenic nerve palsy and diaphragmatic paralysis should not be overlooked during the evaluation of neck trauma.

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The management of penetrating neck injury

Cited by 18 publications

References 41 publications

An audit of surgical neck explorations for penetrating neck injuries in northwestern Nigeria: Experience from a teaching hospital

An audit of surgical neck explorations for penetrating neck injuries in northwestern Nigeria: Experience from a teaching hospital

‘No zone’ approach to the management of stable penetrating neck injuries: a systematic review

Chronic respiratory dysfunction due to diaphragmatic paralysis following penetrating neck trauma

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