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Introduction
The management of penetrating neck trauma has changed
over the past two decades from mandatory exploration
of all wounds that penetrate the platysma to selective
non-operative management of certain injury patterns.
New diagnostic and therapeutic modalities, including
angiography and CT are used as adjuncts to non-operative
or operative strategies.
Exploration of all neck wounds deep to the platysma
leads to a significant number of unnecessary operations
and extra cost. However the consequences of a missed
injury are potentially high. To what extent clinical
examination can be relied upon, and which diagnostic
adjuncts should be employed remain a subject of some
debate. The actual management plans will depend not
only on the specific patient and the injury sustained,
but also on available staffing, expertise, monitoring
and diagnostic modalities.
The structures at risk in penetrating neck injury are
primarily the airway, vascular structures, the oesophagus,
spinal column including the spinal cord, the lower cranial
nerves and the brachial plexus. The thoracic duct is
also at risk in wounds of the left neck. The subsequent
pages will discuss the assessment and primary management
of injuries to these structures.
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