The Viscera and Glands of Neck: Part III (Trauma and Injuries to the Neck)

Trauma to the front and sides of the neck can be potentially life-threatening. Injuries here, place both the airway and the major vessels to the brain at risk. Minor injuries can very quickly become life-threatening, due to the many vessels and delicate structures confined to this tight space. Pathologically, three mechanisms are reported to be responsible for the consequences of the blunt neck trauma, (i) external haemorrhage, (ii) soft tissue haematoma resulting in airway obstruction and (iii) impaired cerebral circulation. Neck hyperextension can result in tracheal tears, vertical fractures of the larynx and trachea, and even complete laryngo-tracheal separation. Direct blows to the neck usually result in injuries to the thyroid and cricoids cartilages. Both mechanisms may occur when the neck is hyperextended following sudden deceleration during a vehicle collision which is followed by a direct impact to the front of the neck as the victim is thrown forward onto the steering wheel. During this impact the trachea and oesophagus may also be injured following compression against the cervical spine. Sudden increases in intratracheal pressure against a closed glottis has also been reported following improper use of seat belts or high impact blunt chest trauma. The most common findings on chest x-ray are subcutaneous emphysema, pneumomediastinum and pneumothorax.