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Go JL, Acharya J, Branchcomb JC, Rajamohan AG. Traumatic Neck and Skull Base Injuries. Radiographics 2019; 39:1796-1807. [PMID: 31589581 DOI: 10.1148/rg.2019190177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with blunt and penetrating traumatic injuries to the skull base and soft tissues of the neck present to the emergency department every day. Fortunately, truly life-threatening injuries to these regions are relatively uncommon. However, when encountered and not correctly diagnosed, these entities may result in severe morbidity or mortality. The radiologist plays a critical role recognizing these injuries, in which findings may often be subtle and the anatomy potentially challenging to identify. Multisection CT and CT angiography are commonly performed to assess these injuries in the emergency department. Vascular injury to the neck may result in dissection, occlusion, pseudoaneurysm formation, or frank extravasation resulting in stroke or death. Airway compromise may result from laryngotracheal injury. Injuries to the pharynx and esophagus may result in perforation. Injuries to the temporal bone may result in vascular injury to the internal carotid artery or facial nerve injury, which would require immediate surgery or intervention to prevent paralysis.©RSNA, 2019.
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Affiliation(s)
- John L Go
- From the Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif, and LAC+USC Medical Center, 1983 Marengo Street, D and T Tower, Room 3D321, Los Angeles, CA 90033
| | - Jay Acharya
- From the Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif, and LAC+USC Medical Center, 1983 Marengo Street, D and T Tower, Room 3D321, Los Angeles, CA 90033
| | - Jasmine C Branchcomb
- From the Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif, and LAC+USC Medical Center, 1983 Marengo Street, D and T Tower, Room 3D321, Los Angeles, CA 90033
| | - Anandh G Rajamohan
- From the Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif, and LAC+USC Medical Center, 1983 Marengo Street, D and T Tower, Room 3D321, Los Angeles, CA 90033
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Petrone P, Velaz-Pardo L, Gendy A, Velcu L, Brathwaite CEM, Joseph DK. Diagnosis, management and treatment of neck trauma. Cir Esp 2019; 97:489-500. [PMID: 31358299 DOI: 10.1016/j.ciresp.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 11/15/2022]
Abstract
Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU..
| | - Leyre Velaz-Pardo
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Amir Gendy
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Laura Velcu
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Collin E M Brathwaite
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - D'Andrea K Joseph
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
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Abstract
The neck visceral space is a complex region housing several vital structures. Diagnostic imaging plays an important role in the evaluation of neck visceral injuries. Many injuries are initially missed by both clinicians and radiologists because of their infrequency and the high likelihood of other more obvious injuries. Understanding which diagnostic modality to apply at given point in the work-up; recognizing relevant clinical signs, symptoms, and injury mechanisms; and knowing pertinent direct and indirect imaging findings of injury allow radiologists to either directly render the correct diagnosis or choose the most appropriate tool for doing so.
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Gomez DE, Desrochers A, Francoz D, Nichols S, Babkine M, Fecteau G. Pharyngeal trauma in dairy cattle: 27 cases. J Vet Intern Med 2019; 33:1833-1839. [PMID: 31058361 PMCID: PMC6639564 DOI: 10.1111/jvim.15510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 04/16/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Characterization of the clinical signs, response to treatment and prognosis can be useful information for decision-making when evaluating cattle with pharyngeal trauma. OBJECTIVE To describe the signalment, history, clinicopathologic, endoscopic, ultrasonographic, radiographic, and postmortem findings as well as treatments and outcomes of cattle diagnosed with pharyngeal perforation/trauma. ANIMALS Review of medical records of cattle >1 month of age admitted to a Veterinary Teaching Hospital from 1995 to 2017. METHODS Retrospective study. Review of medical records of cattle with pharyngeal perforation/trauma identified by oral or endoscopic examination in hospital setting. RESULTS Twenty-seven out of 7550 (0.36%) cases met the inclusion criteria. Pharyngeal perforation/trauma was associated with the administration of a bolus in 24 (89%) cows and a magnet in 3 (11%) cases. The boluses contained monensin (n = 12), calcium salts (n = 5), iodine (n = 1), aspirin (n = 1), vitamins (n = 1), and an unknown product (n = 4). The primary clinical signs were dysphagia, swelling of the throatlatch, subcutaneous emphysema, swelling, and pain on palpation of the throatlatch. Seventeen (63%) cows were discharged whereas 10 (37%) were euthanized. Median time between the suspected traumatic event and hospital admission was 1 day (range: 0.5-3 days) and 2 days (range: 0.5-15) for surviving and nonsurviving cattle, respectively. All 5 cows that suffered pharyngeal trauma associated with administration of calcium salt bolus were euthanized. CONCLUSIONS AND CLINICAL IMPORTANCE Pharyngeal trauma is a rare condition in cattle. Case fatality rate increases if not diagnosed and treated promptly. The nature of the penetrating foreign body influences the outcome.
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Affiliation(s)
- Diego E Gomez
- Department of Large Animal Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - André Desrochers
- Centre Hospitalier Universitaire Vétérinaire, Saint-Hyacinthe, Faculté de Médecine Vétérinaire, Université de Montréal, Montréal, Québec, Canada
| | - David Francoz
- Centre Hospitalier Universitaire Vétérinaire, Saint-Hyacinthe, Faculté de Médecine Vétérinaire, Université de Montréal, Montréal, Québec, Canada
| | - Sylvain Nichols
- Centre Hospitalier Universitaire Vétérinaire, Saint-Hyacinthe, Faculté de Médecine Vétérinaire, Université de Montréal, Montréal, Québec, Canada
| | - Marie Babkine
- Centre Hospitalier Universitaire Vétérinaire, Saint-Hyacinthe, Faculté de Médecine Vétérinaire, Université de Montréal, Montréal, Québec, Canada
| | - Gilles Fecteau
- Centre Hospitalier Universitaire Vétérinaire, Saint-Hyacinthe, Faculté de Médecine Vétérinaire, Université de Montréal, Montréal, Québec, Canada
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Blunt Pharyngoesophageal Injury: an Overview of a Rare Entity. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-0162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park CY, Cho HM, Yeom SR. Tracheal Injury Caused by Self-stabbing over the Low Anterior Neck. ACTA ACUST UNITED AC 2017. [DOI: 10.24184/tip.2017.2.1.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Teixeira F, Menegozzo CAM, Netto SDDC, Poggeti RS, Collet e Silva FDS, Birolini D, Bernini CDO, Utiyama EM. Safety in selective surgical exploration in penetrating neck trauma. World J Emerg Surg 2016; 11:32. [PMID: 27413394 PMCID: PMC4942947 DOI: 10.1186/s13017-016-0091-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/08/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Selective management of penetrating neck injuries has been considered the standard of care with minimal risks to patient safety. In a previous non-randomized prospective study conducted at our center, selective management proved to be safe and reduced unnecessary exploratory cervicotomies. In the present study, the role of clinical examination and selective diagnostic tests were assessed by reviewing demographic and clinical data. A comparison of results between two groups (mandatory surgical exploration versus selective surgical exploration) was made to check the safety of selective management in terms of the rates of morbidity and mortality. METHODS A retrospective analysis at the Emergency Department of the Hospital das Clínicas of the University of Sao Paulo was performed by a chart review of our trauma registry, identifying 161 penetrating neck trauma victims. RESULTS Of the 161 patients, 81.6 % were stabbed and 18.4 % had gunshot injuries. Stratifying the wound entry points by neck zones, we observed that zone I was penetrated in 32.8 %, zone II in 44.1 % and zone III in 23.1 % of all the cases. Thirty one patients (19.2 %) had immediate surgical exploration, which had a mean length of stay of 6 days, a complication rate of 12.9 % and a mortality rate of 9.4 %. Of the 130 who underwent selective surgical exploration 34 (26.1 %) required operative procedures after careful physical examination and diagnostic testing based on clinical indications. The mean length of stay for the selective surgical exploration group was 2 days with a complication rate of 17.6 % with no mortality, and virtually all of them were related to associated injuries in distant body segment. No statistical significance was found comparing mortality and complication rates between the two groups. Selective approach avoided 59 % of unnecessary exploratory cervicotomies. CONCLUSION Careful evaluation of asymptomatic and stable patients with minor signs of injury can safely avoid unnecessary neck explorations with low rates of morbidity. This should be the standard management of such patients.
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Affiliation(s)
- Frederico Teixeira
- Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | - Sérgio Dias do Couto Netto
- Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Renato S. Poggeti
- Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | - Dario Birolini
- Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Celso de Oliveira Bernini
- Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Edivaldo Massazo Utiyama
- Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Defining Zone I of penetrating neck trauma: A surgical controversy in the light of clinical anatomy. J Trauma Acute Care Surg 2016; 80:670-3. [PMID: 26808025 DOI: 10.1097/ta.0000000000000978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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