Learning objectives
- Recognize penetrating neck injuries
- Management of penetrating neck injuries
Definition and mechanism
- Trauma to the neck by breaching the platysma muscle
- Caused by stab wounds, gunshot wounds, self-harm, road traffic accidents, and other high-velocity objects
- Partial or complete occlusion, dissection, pseudoaneurysm, extravasation of blood, or arteriovenous fistula formation
- Potential for serious & life-threatening injuries
- Laryngeal/tracheobronchial tree disruption
- Tension/open pneumothorax, massive hemothorax
- Major vascular disruption
- Esophageal tear
- Spinal cord injury, nerve injury
Signs and symptoms
- Shock
- Active hemorrhage
- Pulsatile bleeding or expanding hematoma
- Audible bruit or papable thrill
- Airway compromise
- Wound bubbling
- Subcutaneous emphysema
- Stridor
- Hoarseness
- Difficulty/pain when swallowing
- Hemiparesis
- Neurological deficits
Anatomical zones of penetrating neck injury
| Zone | Anatomical boundaries | Anatomical structures at risk |
|---|---|---|
| 1 | Superior boundary: skull base Inferior boundary: angle of the mandible | Pharynx Carotid arteries Internal jugular veins Cranial nerves Sympathetic chain Parotid gland |
| 2 | Superior boundary: angle of the mandible Inferior boundary: cricoid cartilage | Laryngotracheal complex Pharynx Oesophagus Carotid artery Jugular veins Vertebral arteries Spinal cord Vagus and phrenic nerves |
| 3 | Superior boundary: cricoid cartilage Inferior boundary: clavicles | Trachea Oesophagus Carotid artery Jugular veins Thoracic duct Spinal cord Cranial nerves Vertebral arteries |
Management
Keep in mind
- Full stomach/RSI vs potentially challenging airway
- Uncooperative patient vs. awake fiberoptic bronchoscopic intubation
- Securing airway vs. consequences of PPV
Suggested reading
- McCann C, Watson A, Barnes D. Major burns: Part 1. Epidemiology, pathophysiology and initial management. BJA Educ. 2022;22(3):94-103.
- Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: a guide to evaluation and management. Ann R Coll Surg Engl. 2018;100(1):6-11.
- Huh H, Han JH, Chung JY, et al. Anesthetic management of penetrating neck injury patient with embedded knife -A case report-. Korean J Anesthesiol. 2012;62(2):172-174.
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