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Management of Penetrating Neck
Injury
Non-operative management of penetrating neck injury
has become increasingly accepted over the past decade,
as numerous studies have shown the efficacy of physical
examination and clinical observation. However, non-operative
strategies are labour intensive and require close nursing
and medical observations in a critical care environment.
Use of adjuncts such as angiography and oesophagoscopy
increase the resource usage and costs. Environments
where such facilities are not available will inevitably
rely on surgical exploration to exclude significant
injury.
The management protocols above currently
do not encompass the use of the CT scanner. As physical
examination is so reliable for penetrating neck injury,
CT scanning has a limited place in the assessment of
these injuries. However, as the diagnostic reliability
of CT improves, especially with the advent of multisclice
helical CT scanning, CT may replace the diagnostic role
of angiography, endoscopy and contrast radiology. However
there is not enough evidence of the efficacy of CT to
recommend it at this stage. CT may currently have a
role in evaluating the unconscious patient, and in stable
gunshot wounds of the neck to assess the path of the
bullet track.
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