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Home > Articles > Penetrating Neck Injury

Penetrating Neck Injury

Karim Brohi, trauma.org 7:6, June 2002


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.

Penetrating Neck Injury

Introduction
Airway
Vascular
- Zone 1
- Zone 2
- Zone 3
Oesophagus
Neural
Management
References

Airway



trauma.org (7:6) June,2002

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