Penetrating trauma to the neck

Penetrating injuries to the neck can cause threatening injuries and damage to many vital structures. Injury patterns associated with penetrating neck trauma are multiple and varied ranging from soft tissue injury to spinal cord transection. Without hard clinical signs such as stridor, dysphagia, or an expanding hematoma, the diagnosis of vital structure injury can be difficult. In the presence of clinically subtle signs or minimal symptoms, adjunctive modalities such as angiography, endoscopy and oesophagography have increased the accuracy in diagnosing these injuries. The routine use of these modalities remains controversial. A retrospective review was performed of 18 patients with penetrating trauma to the neck, evaluated by the Trauma Service of Morehouse School of Medicine, Department of Surgery from July 1994 to July 1997. The injury patterns of the 17 patients who survived more than twenty-four hours were evaluated. Nine patients (53 percent) had injuries to vital structures within the neck, which included: spinal cord injury (3): vascular injury (3); oesophageal injury (1); tracheal injury (1); thyroid cartilage injury (1); and hyoid bone fracture (1). Seven patients had neck explorations and three had no evidence of vital structure injury. Eight patients were evaluated with panendoscopy. Six of these had negative studies, and the two patients with positive studies had injuries noted prior to endoscopy which required operative intervention. Ten patients had oesophagrams which were all negative, and vascular injuries were detected in three of the six patients in whom this procedure was undertaken. The mean hospital stay for all patients was 14.8 days, but this was longer for patients with neck injuries (22.9 days) than for those without neck injury (5.8 days). The average length of stay in the Intensive Care Unit was 6.24 days. Patients with neck injuries had a mean length of stay of 11.6 days compared to those without neck injury whose mean stay was less than one day. In conclusion: (1) angiography remains an important diagnostic tool in the evaluation of patients with penetrating neck trauma; (2) without clinical evidence of vital structure injury, panendoscopy and oesophagography may not be necessary in the routine evaluation of patients with penetrating neck trauma; (3) selective surgical intervention remains an important tool in the evaluation and management of patients with penetrating neck trauma.(AU)