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Ebrahimian R, Moayerifar M, Gholipour M, Mohammadian M, Moayerifar M. Combined tracheoesophageal transection following a life-threatening clothesline-type blunt neck trauma: A case report. Int J Surg Case Rep 2024; 114:109173. [PMID: 38159395 PMCID: PMC10800584 DOI: 10.1016/j.ijscr.2023.109173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Blunt neck trauma is an uncommon, life-threatening injury that may result in tracheoesophageal transection. The manifestations of these traumas are rather vague and nonspecific; therefore, the injury may be missed, if a careful attention is not paid. CASE PRESENTATION A 23-year-old young man presented with complete transection of the trachea and concurrent esophageal injury, caused by clothesline-type blunt neck trauma, while riding a motorcycle. On early examination, the patient was hemodynamically stable; however, after a few minutes, he manifested respiratory distress and progressive subcutaneous emphysema. The airway immediately was secured by inserting an endotracheal tube in distal part of the transected trachea. Afterward, the patient underwent primary repair of transected trachea and esophagus, and tracheostomy. The post-operative period was uneventful. DISCUSSION The blunt traumas to neck, which lead to complete transection of the trachea and the esophagus, are rare injuries. Clothesline-type injuries are the principal reasons for cricotracheal separation and further esophageal injuries. In most cases, subcutaneous emphysema is a sign of significant trauma to the aerodigestive tract. After securing the patient's airway, early surgical repair of the transected trachea and esophagus reduces the risk of further complications. CONCLUSION This report discusses a rare, life-threatening presentation of blunt neck trauma called clothesline-type injury, that led to complete transection of the trachea and concurrent esophageal rupture. Establishing a secure airway for those patients with tracheal injuries is required. Repairing the injured trachea and esophagus primarily at the earliest possible time can improve the patient prognosis and prevent further complications.
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Affiliation(s)
- Ramin Ebrahimian
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maziar Moayerifar
- Department of Vascular Surgery, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Maede Mohammadian
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mani Moayerifar
- Razi Clinical Research Development Unit, Guilan University of medical Sciences, Rasht, Iran.
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Sachdeva K, Vatsyayan R. A Prospective Study of Management of Neck Trauma and its Complications : An Institutional Approach. Indian J Otolaryngol Head Neck Surg 2023; 75:895-901. [PMID: 37275081 PMCID: PMC10234975 DOI: 10.1007/s12070-023-03533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
Background: Assessment and immediate surgical management of laryngotracheal injuries is essential to minimize the risk of perioperative and long term complications [1]. The present study was conducted at tertiary care centre to assess the proportions of complications following neck injuries. Methodology: The study was conducted as a prospective study on 19 patients presenting with laryngotracheal injuries at Emergency department in NSCB Medical College, Jabalpur, India during the study period of 2 years. History was obtained in detail and depending upon the extent and nature of injury, patients were managed. Patients were followed up till discharge for assessment of any postoperative complications. Results: A total of 19 cases with neck trauma were enrolled during our study period with mean age of 27.37±8.88 years. Tracheal breach was noted in 78.9% cases. The most common site of airway injury was tracheal wall (47.3%), followed by Laryngeal trauma with unilateral or bilateral thyroid cartilage (15.8%). Major vessels injury was noted in 26.3% cases and injury to minor blood vessels was observed in 68.4% cases. Wound exploration followed by wound repair was done in 36.8% of the cases whereas emergency tracheostomy along with wound repair was done in 31.6% of the cases. During surgery, brachial plexus injury and surgical site infection were the surgical complications in 1 case each. However, anemia psychiatric tendency and symptoms due to alcohol withdrawal were the complications in 1 case each. Among postoperative complications, persistence of psychiatric symptoms, recurrent laryngeal nerve palsy, withdrawal symptoms, and complications due to brachial plexus injury persisted. Conclusion: Neck injuries and laryngotracheal injuries are rare but life threatening injuries, timely management of which is essentially important to avoid the occurrence of complications. Management often requires multidisciplinary approach due to associated complications. The complications may be immediate or remote which can be prevented if patients are managed timely. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03533-7.
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Affiliation(s)
- Kavita Sachdeva
- Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, Madhya Pradesh India
| | - Richa Vatsyayan
- Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, Madhya Pradesh India
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3
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Alves DG, Sousa J, Ferreira V, Almeida Pinto J, Teixeira N. Anterior Penetrating Neck Injury: A Path to the Cervical Spine. Cureus 2023; 15:e35370. [PMID: 36994302 PMCID: PMC10042214 DOI: 10.7759/cureus.35370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
While rare in incidence, penetrating neck injuries are often life-threatening. When a patient's physiological status is appropriate, the first step in treatment should be a detailed preoperative imaging assessment. Formulating a treatment plan that includes computed tomography (CT) imaging and discussing the surgical approach with a multidisciplinary team before operating allows for a successful selective surgical approach. The authors report the case of a Zone II penetrating injury with a right laterocervical entry wound in which an impaled blade with an inferomedial oblique path pierced deeply into the cervical spine. The blade missed multiple vital structures in the neck, such as the common carotid artery, jugular vein, trachea, and esophagus. The patient underwent a formal neck exploration, and controlled extraction of the blade under direct vision was achieved. Therefore, the author's recommendation for implementing any management algorithm for penetrating neck injuries should rely primarily on a multidisciplinary selective approach.
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Blunt and Penetrating Airway Trauma. Emerg Med Clin North Am 2023; 41:e1-e15. [PMID: 36639169 DOI: 10.1016/j.emc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Airway injury, be that penetrating or blunt, is a high-stakes high-stress management challenge for any airway manager and their team. Penetrating and blunt airway injury vary in injury patterns requiring prepracticed skills and protocols coordinating care between specialties. Variables including patient cooperation, coexisting injuries, cardiorespiratory stability, care location (remote vs tertiary care center), and anticipated course of airway injury (eg, oxygenating well and comfortable vs increasing subcutaneous emphysema) all play a role in determining airway if and when airway management is required. Direct airway trauma is relatively infrequent, but its presence should be accompanied by in-person or virtual otolaryngology support.
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Raghunathan N, Thangavel S, Kalyanasundaram A, Ganesan S, Saxena SK. How Can We Manage Penetrating Neck Injury with Blunt Carotid Injury and Spinal Injury: Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:5817-5822. [PMID: 36742762 PMCID: PMC9895334 DOI: 10.1007/s12070-021-02415-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
The Neck is a cylindrical structure containing vital neurovascular and visceral structures tightly packed in a relatively small volume. Mortality rate increases when there is an injury to vascular structures especially the carotid artery, surrounded by other vital neurovascular structures; injuring the neck leads to devastating morbidity when compared to other injuries. With increased awareness of screening techniques and improved detection rates, there is an urge in opting for selective neck exploration and initial aggressive antithrombotic therapy for blunt carotid artery injuries. Here we report a case of a 20-year-old male, with a lacerated injury of the right side of the neck causing transection of the right internal jugular vein, grade 4 (Denver classification) blunt carotid injury, along with cervical vertebral fractures without neurological deficits. The patient underwent emergency surgical neck wound exploration, flush ligation of transacted Right Internal Jugular Vein, and conservative management for blunt carotid artery injury using anti platelets (Aspirin and Clopidogrel) avoiding any immediate neurological deficits. Whenever lacerated neck wounds are evaluated, the chance of blunt injury to the carotid is to be borne in mind and such an injury can be managed with double antiplatelet therapy, if there are no demonstrable neurological deficits.
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Affiliation(s)
- Nipun Raghunathan
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Saranya Thangavel
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Aravind Kalyanasundaram
- Department of CTVS, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sivaraman Ganesan
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Sunil Kumar Saxena
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
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Pediatric Penetrating Neck Trauma Resulting From a Metal Boat Cleat: A Case Report. J Trauma Nurs 2022; 29:325-329. [DOI: 10.1097/jtn.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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7
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Muacevic A, Adler JR. Laryngeal Trauma, Its Types, and Management. Cureus 2022; 14:e29877. [PMID: 36348916 PMCID: PMC9629857 DOI: 10.7759/cureus.29877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Abstract
Laryngotracheal wounds are rare; however, they have a significant mortality rate. These wounds can be blunt or penetrating. Usually, the larynx is protected from blunt trauma by the sternum and jaw. A "clothesline" injury happens when the exposed neck is struck by a hard object, such as a wall wire or tree branch, or when an attack is intended to damage the larynx. Additionally, injuries may occur when the neck is stressed due to damage, such as in a rear-end accident that causes a whiplash-like injury or when the larynx is intentionally targeted for harm. Penetrating neck trauma may result in injury to the larynx. Assume a patient has suffered a penetrating or severe neck injury. It is usually evident from their medical history or a quick trauma evaluation in that case. However, it is recommended to be cautious for anterior neck injuries in general and to have a low threshold for establishing a surgical airway. The priority is securing an airway when a patient with a laryngeal injury arrives in the emergency room. The operating surgeon may request any flexible laryngoscopy, computed tomography (CT), esophagram, and chest X-ray for additional examination, depending on the nature of the damage and the patient's health. After the examination, the initial step in treating laryngeal injuries should be to locate and secure the airway. According to the evaluation and management based on the Schaefer classification system for laryngeal injury, the patient is treated based on whether the patient has impending airway obstruction or a stable airway. Medical management or observation and surgical management depend on the site and severity of the injury, patient condition, and type of injury. There are several complications related to laryngotracheal trauma, which can be minor or even fatal. Following successful treatment, postoperative and rehabilitative care, vocal rest, speech therapy, and swallowing therapy may be necessary.
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8
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Noh D, Choi JH. Outcomes of open neck injuries. JOURNAL OF TRAUMA AND INJURY 2022. [DOI: 10.20408/jti.2021.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: The neck is a particularly critical region for penetrating injuries due to the close proximity of the trachea, esophagus, blood vessels, and the spinal cord. An open neck injury has the potential for serious morbidity and mortality. The purpose of this study is to evaluate the assessment and management of open neck injuries. Methods: In this retrospective study, open neck injury patients who were admitted to NAME University Hospital Trauma Center between December 2015 and December 2017 were analyzed for epidemiology, the mechanism of trauma, the injured organ, complications, and mortality. Results: Thirty-two patients presented with open neck injuries. All patients underwent computed tomographic angiography to evaluate their injuries once their vital signs stabilized. Among these patients, 27 required surgical treatment. The most commonly injured organ was the airway. There were five deaths, and the main cause of death was bleeding. Mortality was associated with the initial systolic blood pressure at the hospital and Glasgow Coma Scale. Conclusions: Mortality from open neck injuries was associated with initial systolic blood pressure at the hospital and Glasgow Coma Scale.
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Ramírez-Morin MA, Vergara-Miranda H, Guerrero-Arroyo AA, Álvarez-Lozada LA, Martínez-Zarazua RO, De la Cruz-de la Cruz C, Vásquez-Fernández F, Muñoz-Maldonado GE. Trauma cervical penetrante: experiencia de un hospital de enseñanza en México. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El trauma cervical penetrante es una entidad poco frecuente, con tendencia al alza, de considerable morbimortalidad. Es fundamental conocer su manejo por cirujanos en entrenamiento, quienes en su mayoría son comúnmente los proveedores del tratamiento en las áreas de urgencias. El objetivo de este estudio fue demostrar la experiencia de un centro de trauma en México en el tratamiento de trauma cervical penetrante administrado por cirujanos en entrenamiento.
Métodos. Estudio retrospectivo de pacientes con diagnóstico de trauma cervical penetrante sometidos a exploración cervical entre los años 2014 y 2019. Se identificaron 110 expedientes, se excluyeron 26 por falta de datos indispensables para la investigación y se analizaron los datos de 84 pacientes.
Resultados. El 96,4 % de los pacientes fueron hombres, la mayoría entre 16 y 50 años (83,3 %) y la zona anatómica II fue la más comúnmente lesionada (65,4 %). Las etiologías más frecuentes fueron heridas por arma cortopunzante (67,9 %) y heridas por proyectil de arma de fuego (25 %). El 95 % de los procedimientos fueron realizados por residentes de cuarto y quinto año. La mediana de días de estancia hospitalaria fue de 2 días. La incidencia de complicaciones fue de 9,5 % y la mortalidad de 1,2 %.
Conclusiones. Los cirujanos generales en etapa de formación entrenados en centros de trauma tienen la capacidad de tratar de forma óptima el trauma cervical penetrante sin modificación de las tasas de morbimortalidad descritas en la literatura internacional.
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10
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Spontaneous Recovery of Penetrating Cervical Spinal Cord Injury with Physiotherapeutic Treatment: Case Report and Review of the Literature. Case Rep Neurol Med 2022; 2021:3741461. [PMID: 34987873 PMCID: PMC8720595 DOI: 10.1155/2021/3741461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Stab wounds to the cervical spine are less common than injuries from road accidents, sports injuries, and falls. The presence of vital, vascular, neural, respiratory, and digestive structures in the neck region mean that this kind of spinal injury is generally critical, and its management is a challenge. We report a unique case of a previously healthy 17-year-old adolescent admitted for quadriplegia secondary to a stab wound to the cervical spine at the C4C5 level. There was no surgical indication. The patient underwent physiotherapy. He showed spontaneous neurological improvement two weeks later and was able to sit on his own and to walk about three months of physical rehabilitation.
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11
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Paladino L, Baron BJ, Shan G, Sinert R. Computed tomography angiography for aerodigestive injuries in penetrating neck trauma: A systematic review. Acad Emerg Med 2021; 28:1160-1172. [PMID: 34021515 DOI: 10.1111/acem.14298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Management of hemodynamically stable patients with penetrating neck trauma (PNT) has evolved in recent years with improvements in imaging technology. Computed tomography angiography (CTA) encompassing all zones of the neck has become part of the standard diagnostic algorithm for PNT patients who do not require immediate surgical intervention for vascular or aerodigestive injuries (ADI). Several studies have demonstrated favorable operating characteristics for CTA at excluding arterial injuries; however, consensus as to CTA's ability to detect ADI is lacking. We conducted a systematic review (PROSPERO registration number CRD42019133509) to answer the question Is CTA sufficient to rule out ADI in hemodynamically stable PNT patients without hard signs? METHODS Investigators independently searched PubMed, EMBASE, and Web of Science from their inception to August 2020 for the search terms "penetrating neck injuries" and "CT scan." To be included, studies required sufficient data to construct a 2×2 table of CTA for ADI. The operating characteristics of CTA for detecting ADIs are reported as sensitivity, specificity, and likelihood ratios (LRs), with 95% confidence intervals (95% CIs). Bias in our studies was quantified by QUADAS-2. RESULTS Our search identified 1,242 citations with seven studies with moderate to high risk of bias meeting our inclusion/exclusion criteria and encompassing 877 subjects with an ADI prevalence of 13.4%. CTA for ADI had sensitivity of 92% (95% CI = 85% to 97%), specificity of 88% (95% CI = 85% to 90%), positive likelihood ratio of 12.2 (95% CI = 4.6 to 32), and negative LR of 0.14 (95% CI = 0.05 to 0.37). Of the 26 identified esophageal injuries across our studies that were diagnosed by either swallow studies or surgical exploration, five (19%, 95% CI = 8.1% to 38.3%) were initially missed by CTA. CONCLUSION CTA alone is not sufficient to exclude esophageal injuries in PNT. Because delayed diagnosis is associated with increased morbidity, additional diagnostic interventions should be undertaken if there is remaining concern for esophageal injury.
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Affiliation(s)
- Lorenzo Paladino
- Department of Emergency Medicine State University of New York Downstate Health Sciences University and NYC Health Hospitals Kings County Brooklyn New York USA
| | - Bonny J. Baron
- Department of Emergency Medicine State University of New York Downstate Health Sciences University and NYC Health Hospitals Kings County Brooklyn New York USA
| | - Gururaj Shan
- Department of Emergency Medicine State University of New York Downstate Health Sciences University and NYC Health Hospitals Kings County Brooklyn New York USA
| | - Richard Sinert
- Department of Emergency Medicine State University of New York Downstate Health Sciences University and NYC Health Hospitals Kings County Brooklyn New York USA
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Shehri SZA, Ababtain RA, Fotawi RA, Alkindi M, Premnath S, Alhindi M, Divakar DD. Pediatric maxillofacial and dental trauma: A retrospective review of pediatric emergency management in Riyadh, Kingdom of Saudi Arabia. Saudi Dent J 2021; 33:328-333. [PMID: 34434035 PMCID: PMC8376668 DOI: 10.1016/j.sdentj.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/10/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Due to the high prevalence of oral and maxillofacial (OMF) trauma in city of Riyadh, a special focus on pediatric trauma is needed. The purpose of this audit was to assess the protocol followed by the OMF unit at King Khalid University Hospital (KKUH) on pediatric trauma patients. The trauma incidence, mechanism of injury, volume, the type of pediatric trauma operated and dental management were analyzed. MATERIALS AND METHODS A quantitative retrospective review of 223 patients, at pediatric emergency unit of KKUH, Riyadh, KSA from January 2017 to July 2018, was done. The data retrieved included variables such as, age, gender, and cause of injury, site of injury, type of injury, and assessment of jaws, and teeth. Data regarding the type of investigations, treatment protocol, follow up visit, and dental management, were extracted from the medical records. RESULTS Of the 223 pediatric patients presenting to the emergency unit, 116 (52%) were under the age of 5 years. A total of 64.4% of patients reported "self-fall" as the cause of injury. Soft-tissue injuries were common in 63 (56.8%) of patients in the form of lacerations 87 (41.2%). Involvement of the teeth in the injury was observed in 57 patients, in which 33 (57.9%) patients were reported to have tooth/teeth avulsions, 15 (26.3%) patients had luxation and 9 (15.8%) patients had crown fractures. 27 (47%) patients were referred to the pedodontist for a follow-up visit. CONCLUSIONS It can concluded that clinicians facing maxillofacial trauma in an emergency department need to have access to useful and practice guidelines. The study also showed the need for more manpower-oriented training such as a pedodontist and a general dentist to join the OMFS team to manage pediatric patients. The regional referral hospitals should be equipped to decentralize the management of these patients to the Dental University Hospital.
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Affiliation(s)
- Saleh Zaid Al Shehri
- Department of Oral and Maxillofacial Surgery, King Saud University, Riyadh, Saudi Arabia
| | | | - Randa Al Fotawi
- Department of Oral and maxillofacial surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alkindi
- Department of Oral and maxillofacial surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sangeetha Premnath
- Department of Oral and maxillofacial surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Maryam Alhindi
- Department of Oral and maxillofacial surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Darshan Devang Divakar
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Rodriguez-Ortiz LR, Perez-Torres AM, Saldaña-Mendez AN, Labat-Alvarez EJ. A Rare Case of Traumatic Thyroid Gland Hypoperfusion/Devascularization After a Gunshot Wound Through the Neck: Computed Tomography Findings. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930505. [PMID: 34456332 PMCID: PMC8420712 DOI: 10.12659/ajcr.930505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The thyroid gland is rarely injured in cases of penetrating neck trauma. Computed tomography (CT) plays a central role in prompt evaluation of the extent of penetrating neck trauma and can demonstrate thyroid gland injury. The current literature on thyroid gland injury is limited mostly to blunt trauma, with little emphasis on findings seen on CT imaging. In the present case report, we focus on CT imaging findings of thyroid gland hypoperfusion/devascularization in a patient who had a gunshot wound injury through the base of his neck. CASE REPORT A 26-year-old man was transferred to our trauma center after experiencing multiple gunshot wounds, including one through the base of the neck. The bullet path through his neck was associated with enlargement/edema involving the right thyroid lobe, with an asymmetric decrease in enhancement involving the mid and superior aspects of the right thyroid lobe. Maximum-intensity-projection angiographic images of the vascular supply of the thyroid gland suggested an abrupt decrease in caliber close to the origin of the posterior glandular branch of the right superior thyroid artery. The findings favored vasospasm rather than an arterial injury, which led to hypoperfusion/devascularization of the upper pole of the right thyroid lobe. CONCLUSIONS Thyroid gland hypoperfusion/devascularization after a penetrating neck injury is rare. Recognition of CT imaging findings that favor post-traumatic organ hypoperfusion/devascularization is crucial for prompt management and to decrease morbidity in such cases.
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Khatib B, Gelesko S, Amundson M, Cheng A, Patel A, Bui T, Dierks EJ, Bell RB. Updates in Management of Craniomaxillofacial Gunshot Wounds and Reconstruction of the Mandible. Oral Maxillofac Surg Clin North Am 2021; 33:359-372. [PMID: 34210400 DOI: 10.1016/j.coms.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article includes updates in the management of mandibular trauma and reconstruction as they relate to maxillomandibular fixation screws, custom hardware, virtual surgical planning, and protocols for use of computer-aided surgery and navigation when managing composite defects from gunshot injuries to the face.
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Affiliation(s)
- Baber Khatib
- Advanced Craniomaxillofacial and Trauma Surgery/Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Surgery, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Portland Hospital, 4805 NE Glisan Street, Portland, OR 97213, USA; Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA.
| | - Savannah Gelesko
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA
| | - Melissa Amundson
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - Allen Cheng
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, 1015 NW 22nd Avenue, Portland, OR 97210, USA
| | - Ashish Patel
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
| | - Tuan Bui
- Oral and Maxillofacial Pathology, Sanford Health, E - 1717 S University Drive Fargo, ND 58103, USA
| | - Eric J Dierks
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - R Bryan Bell
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA; Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
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Ajiya A, Shuaibu IY, Anka HM. An Audit of Surgical Neck Explorations for Penetrating Neck Injuries in Northwestern Nigeria: Experience from a Teaching Hospital. Niger J Surg 2021; 27:48-54. [PMID: 34012242 PMCID: PMC8112368 DOI: 10.4103/njs.njs_63_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Penetrating neck injury is a major trauma mechanism present in about 5%–10% of trauma patients with an estimated mortality of 3%–10%. The management of these injuries is dependent on the anatomical level of injury. Objectives: The objective of the study was to document the clinical and operative findings as well as the treatment outcome among our patients who underwent neck exploration for penetrating neck injuries. Materials and Methods: A retrospective review of patients who had neck exploration for penetrating neck injury between January 2012 and December 2018 was done. Results: Thirty-five patients all of whom had surgical neck exploration were included. The age ranged from 15 to 62 years with a male: female of 7.8:1. The mean age was 30.7 years with standard deviation of ± 12.5 years and the peak age of occurrence of 20–29 years. The mechanism of injury was commonly arrow injury in 9 (25.7%) and suicidal cutthroat in 7 (20%) patients. Thirty-two (91.4%) patients presented with stable vital signs. Zone II neck injuries were most prevalent, seen in 23 (65.7%) patients. Laryngeal injury in 7 (20%) and soft-tissue injury in 7 (20%) of the patients were the most common intraoperative findings. The complication rate of 17.1% with a mortality rate of 2.9% was recorded. There was a statistically significant association between the presence of vascular injury and the development of complications after exploration (Chi-square = 5.666, P = 0.017). It was also a significant positive predictor of complication following neck exploration (odds ratio = 0.017, P = 0.048). Conclusion: Male young adults were most involved, commonly from arrow and stab injuries. Although laryngeal and soft-tissue injuries were predominant, vascular injuries were most associated with postoperative complications.
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Affiliation(s)
- Abdulrazak Ajiya
- Department of Otorhinolaryngology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Iliyasu Yunusa Shuaibu
- Department of Surgery, Division of Otorhinolaryngology, Faculty of Clinical Sciences, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Hamza Manir Anka
- Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
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16
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Kansagra AP, Balasetti V, Huang MC. Neurovascular trauma: Diagnosis and therapy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:325-344. [PMID: 33272402 DOI: 10.1016/b978-0-444-64034-5.00012-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Traumatic cerebrovascular injuries are common in both military and civilian populations. Whether such injuries occur in the aftermath of blunt or penetrating trauma has major implications for characteristics, classification, diagnosis, and optimal management of these lesions. Advances in screening methods, including particularly the dramatic rise of high-quality CT angiography, have facilitated early detection of these lesions. Fortunately, these diagnostic advances have occurred alongside improvements in pharmacological treatment and endovascular intervention, which now play an important role alongside surgical intervention in reducing the likelihood of adverse clinical outcomes. While the management of victims of trauma remains challenging, improved understanding of and ability to appropriately manage traumatic cerebrovascular lesions promises to yield better clinical outcomes for these vulnerable patients.
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Affiliation(s)
- Akash P Kansagra
- Departments of Radiology, Neurological Surgery, and Neurology, Washington University School of Medicine, St. Louis, MO, United States.
| | - Vamshi Balasetti
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael C Huang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
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17
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Quax MLJ, Eefting D, Jansen JC, Blok JJ. A 'Final Destination injury': Penetrating trauma of the neck and a pneumomediastinum by a metal part shot from a lawnmower. Trauma Case Rep 2020; 31:100379. [PMID: 33364293 PMCID: PMC7750575 DOI: 10.1016/j.tcr.2020.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 10/31/2022] Open
Abstract
Introduction Outside of war regions, penetrating neck injury is rare. Penetrating neck injury due to a lawnmower has never been described, despite the annual 74.000 injuries caused by lawnmowers in the United States. In this report, the case of a 65-year old women, admitted after a penetrating neck injury due to a metal piece shot from a lawnmower, is described. Report A 65-year old women, with no relevant medical history, presented at the Emergency Department after she was hit in the neck by an iron projectile shot from a professional lawnmower. On site, the projectile, a metal part from the lawnmower blade, was removed by her husband. CT scan showed a pneumomediastinum, without signs of vascular injury. Surgical exploration was immediately performed in the operation room (OR). No vascular or esophageal injuries werefound, only lacerated neck muscles. Perioperatively, the ENT surgeon performed an endoscopy, which showed a small injury of the hypopharynx. Postoperatively, the patient was prophylactically treated with antibiotics for 7 days. Patient was discharged in good clinical condition after 7 days, without complications. Conclusion In this report we present a case with a sharp traumatic injury of the neck, caused by a metal projectile shot from a lawnmower. The laceration of the pharynx was explored in the OR by the ENT- and vascular surgeon. The pneumomediastinum was treated with prophylactic antibiotics. Currently the patient is doing fine without any complications of the injury. Traumatic injury of the neck requires direct direct surgical exploration, however, when patients present hemodynamically stable, a neck CTA will add to the diagnosis (e.g. a pneumomediastium).
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Affiliation(s)
- Marcel L J Quax
- Departments of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel Eefting
- Departments of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen C Jansen
- Departments of Otorhinolaryngology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joris J Blok
- Departments of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
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18
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Ko JW, Gong SC, Kim MJ, Chung JS, Choi YU, Lee JH, Jung PY. The efficacy of the "no zone" approach for the assessment of traumatic neck injury: a case-control study. Ann Surg Treat Res 2020; 99:352-361. [PMID: 33304863 PMCID: PMC7704270 DOI: 10.4174/astr.2020.99.6.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/11/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose Recently, several studies have demonstrated symptom-based, non-zonal algorithms for approaching penetrating neck injuries. The purpose of this study was to confirm the effectiveness of the “no zone” approach in traumatic neck injuries. Methods Medical charts of patients with traumatic neck injuries who presented at the Regional Trauma Center in South Korea between January 2014 and December 2018 were retrospectively reviewed. Negative final neck findings (FNFs) were compared with positive FNFs (which include major vascular, aerodigestive, nerve, endocrine gland, cartilage, or hyoid bone injuries) using multivariate logistic regression analysis including values of the “zone” and/or no zone approach. Results Out of 168 trauma patients, 70 patients with a minor injury and 7 patients under the age of 18 years were excluded. Of the remaining 91 patients, 74 (81.3%) had penetrating neck injuries and 17 (18.7%) had blunt neck injuries. Initial diagnosis most frequently revealed external wounds in zone II (84.6%). Twenty (22.0%) and 36 (39.5%) patients had hard and soft signs, respectively, using the no zone approach. Further, there was a significant difference between the negative and positive FNFs in patients with hard signs (11.6% vs. 54.5%; P < 0.01, respectively). According to the multivariate logistic regression analysis, the hard signs were associated with an odds ratio (OR) for FNFs (OR, 18.92; 95% confidence interval, 3.55–157.60). Conclusion Traumatic neck injuries classified as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.
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Affiliation(s)
- Ji Wool Ko
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Seong Chan Gong
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Myung Jun Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Jae Sik Chung
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Young Un Choi
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Jun Hyuk Lee
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Pil Young Jung
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
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19
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Shiroff AM, Gale SC, Martin ND, Marchalik D, Petrov D, Ahmed HM, Rotondo MF, Gracias VH. Penetrating Neck Trauma: A Review of Management Strategies and Discussion of the ‘No Zone’ Approach. Am Surg 2020; 79:23-9. [DOI: 10.1177/000313481307900113] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The evaluation and management of hemodynamically stable patients with penetrating neck injury has evolved considerably over the previous four decades. Algorithms developed in the 1970s focused on anatomic neck “zones” to distinguish triage pathways resulting from the operative constraints associated with very high or very low penetrations. During that era, mandatory endoscopy and angiography for Zone I and III penetrations, or mandatory neck exploration for Zone II injuries, became popularized, the so-called “selective approach.” Currently, modern sensitive imaging technology, including computed tomographic angiography (CTA), is widely available. Imaging triage can now accomplish what operative or selective evaluation could not: a safe and noninvasive evaluation of critical neck structures to identify or exclude injury based on trajectory, the key to penetrating injury management. In this review, we discuss the use of CTA in modern screening algorithms introducing a “No Zone” paradigm: an evidence-based method eliminating “neck zone” differentiation during triage and management. We conclude that a comprehensive physical examination, combined with CTA, is adequate for triage to effectively identify or exclude vascular and aerodigestive injury after penetrating neck trauma. Zone-based algorithms lead to an increased reliance on invasive diagnostic modalities (endoscopy and angiography) with their associated risks and to a higher incidence of nontherapeutic neck exploration. Therefore, surgeons evaluating hemodynamically stable patients with penetrating neck injuries should consider departing from antiquated, invasive algorithms in favor of evidence-based screening strategies that use physical examination and CTA.
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Affiliation(s)
- Adam M. Shiroff
- Department of Surgery, Division of Acute Care Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey; the
| | - Stephen C. Gale
- Department of Surgery, Division of Acute Care Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey; the
| | - Niels D. Martin
- Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel Marchalik
- Department of Surgery, Division of Acute Care Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey; the
| | - Dmitriy Petrov
- Department of Surgery, Division of Acute Care Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey; the
| | - Hesham M. Ahmed
- Department of Surgery, Division of Acute Care Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey; the
| | - Michael F. Rotondo
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Vicente H. Gracias
- Department of Surgery, Division of Acute Care Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey; the
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20
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Jenkins LN, Rezende-Neto JB. Current Management of Penetrating Traumatic Cervical Vascular Injuries. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00258-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Isaza-Restrepo A, Quintero-Contreras JA, Escobar-DiazGranados J, Ruiz-Sternberg ÁM. Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test. BMC Emerg Med 2020; 20:17. [PMID: 32151240 PMCID: PMC7063736 DOI: 10.1186/s12873-020-00311-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/14/2020] [Indexed: 12/04/2022] Open
Abstract
Background There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. Methods We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. Results The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered “asymptomatic” as they didn’t present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5–99.5%] and 98.7% [CI] [92.8–99.8%] respectively, with a range of confidence [CI] of 95%. Conclusions Our study’s main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.
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Affiliation(s)
- Andrés Isaza-Restrepo
- Escuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del Rosario, Carrera 24 No 63C-69 Barrio Siete de Agosto, Bogotá, DC, Colombia. .,Méderi Hospital Universitario Mayor, Bogotá, DC, Colombia.
| | | | - Jorge Escobar-DiazGranados
- Escuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del Rosario, Carrera 24 No 63C-69 Barrio Siete de Agosto, Bogotá, DC, Colombia
| | - Ángela María Ruiz-Sternberg
- Escuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del Rosario, Carrera 24 No 63C-69 Barrio Siete de Agosto, Bogotá, DC, Colombia
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22
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Carotide-jugular fistula due to vascular trauma with chain saw. Diagnostic and surgical approach. ANGIOLOGIA 2020. [DOI: 10.20960/angiologia.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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23
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Schubl SD, Woods AL, de Virgilio C, Kim DY. Gunshot Wound to the Left Neck. Surgery 2020. [DOI: 10.1007/978-3-030-05387-1_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Fan X, Li Y, Li X, Wu Y, Tang K, Liu J, Zheng X, Wan G. Injectable antibacterial cellulose nanofiber/chitosan aerogel with rapid shape recovery for noncompressible hemorrhage. Int J Biol Macromol 2019; 154:1185-1193. [PMID: 31730972 DOI: 10.1016/j.ijbiomac.2019.10.273] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 01/08/2023]
Abstract
Here an injectable antibacterial aerogel was fabricated with oxidized cellulose nanofiber and chitosan for rapid hemostasis of noncompressible hemorrhage application. Especially, cellulose nanofiber was modified with carboxyl groups by pre-oxidizing in 2,2,6,6-tetramethylpiperidine-1-oxyl combined with high pressure homogenization. Whereafter, the realized carboxyl group of cellulose nanofiber was reacted with the amidogen of chitosan to yield a strong composite aerogel with a nanofiber/nanosheet interlaced structure, which increased the compressive mechanical strength up to 75.4 kPa. In addition, the nanocellulose/chitosan composite aerogel exhibits high water absorption capacity, rapid shape recovery and good antibacterial ability (via Escherichia coli and Staphylococcus aureus). Once absorbing water, the nanocellulose5/chitosan5 compressed aerogel could rapidly recover its shape within 30 s. The in vitro coagulation ability measurement showed that the composite aerogel has a good adhesion and aggregation effect to red blood cells and platelets. Hemolysis and cytotoxicity analysis results indicated a good biocompatibility for the composite aerogel.
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Affiliation(s)
- Xialian Fan
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Yijin Li
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiumin Li
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Yonghui Wu
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Keyong Tang
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China.
| | - Jie Liu
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Xuejing Zheng
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Guangming Wan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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25
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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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Abstract
Penetrating neck injuries are becoming more common because of the increasing prevalence of knife and gun crimes. The immediate and long-term consequences of injury to the neck can be significant because of the close relationship of important anatomical structures in a confined space. Delayed recognition of major injury and inadequate treatment results in high morbidity and mortality. Developing a clear understanding of the underlying anatomy, common mechanisms of injury and principles of management will provide first responders, emergency doctors and trauma surgeons with confidence in appropriate evidence-based management. Early involvement of otolaryngologists or head and neck surgeons is advisable. Two cases of penetrating neck injury from the June 2017 London Bridge terror attack are discussed.
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Affiliation(s)
- A M Khan
- Core Surgical Trainee, Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT
| | - J C Fleming
- Specialist Registrar in Head and Neck Surgery, Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London
| | - J P Jeannon
- Consultant Head and Neck Surgeon, Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London
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27
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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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28
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Penetrating neck trauma: radiological predictors of vascular injury. Eur Arch Otorhinolaryngol 2019; 276:2541-2547. [PMID: 31218447 DOI: 10.1007/s00405-019-05517-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Vascular injury in penetrating neck trauma predicts a poorer outcome and usually requires surgical neck exploration. Multi-detector computed tomography (MDCT) angiography is a readily available non-invasive diagnostic tool that can identify direct and indirect signs of vascular injury in stable patients. This study aims to investigate the diagnostic accuracy of radiological signs of vascular injury on MDCT, and their implications on patient management in the setting of penetrating neck trauma. METHODS A retrospective cohort study of penetrating neck injuries (PNI) between 2012 and 2018 in a UK major trauma centre was performed. Clinical data and operative findings were compared with radiological findings on MDCT performed at the time of admission. RESULTS 157 patients were identified with PNI in the study period, with 67 meeting inclusion criteria. The predictive value of indirect radiological signs of vascular injury alone was low, with only 12.1% of these patients having significant vascular injury found at neck exploration. However, the combined use of direct radiological signs with clinical signs resulted in a specificity of 97.7% for vascular injury. CONCLUSIONS The use of direct and indirect radiological signs of vascular injury can increase the accuracy of diagnosis when used in conjunction with clinical signs. Combining clinical assessment and radiological investigation, specifically contrast-enhanced MDCT, improves the specificity in pre-operative assessment of potential vascular injury in PNI. MDCT is recommended in stable patients with clinical signs of vascular injury to reduce the rate of negative neck exploration.
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29
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Ahlawat G, Jaiswal R, Singhal S, Saini S, Hooda S. A unique method of intubating an unusual neck injury with knife-in-situ. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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31
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Abstract
Penetrating neck injuries are serious as there is a high concentration of vital structures in close proximity to each other in a compressed anatomical area. Penetrating neck injuries can be immediately life threatening due to massive bleeding from vascular structures or due to airway compromise. Injury to the digestive tract in the neck may also result in delayed and potentially life-threatening conditions. The majority (79%) of penetrating neck injuries can be managed conservatively. The clinician caring for such a patient requires a structured and comprehensive approach to managing these injuries. This article will provide a general overview of penetrating neck injuries, including resuscitation, epidemiology, surgical management and the use of appropriate imaging.
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Affiliation(s)
- R Weale
- Department of General Surgery, Wessex Deanery, Wessex, UK
| | - A Madsen
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - VY Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - DL Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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32
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Kim JH, Jung SW, Lee JS, Park JM, Yoon HD, Rhee JT, Kim SW, Lim B, Kim SR, Jung IY. Analysis of Neck Trauma Patients Using the Korean National Emergency Department Information System. JOURNAL OF ACUTE CARE SURGERY 2018. [DOI: 10.17479/jacs.2018.8.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jung Hun Kim
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Sung Won Jung
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Jin Suk Lee
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Jong-Min Park
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Han Deok Yoon
- National Trauma System Management Office, National Medical Center, Seoul, Korea
| | - Jung Tak Rhee
- National Trauma System Management Office, National Medical Center, Seoul, Korea
| | - Sun Worl Kim
- National Trauma System Management Office, National Medical Center, Seoul, Korea
| | - Borami Lim
- National Trauma System Management Office, National Medical Center, Seoul, Korea
| | - So Ra Kim
- National Trauma System Management Office, National Medical Center, Seoul, Korea
| | - Il-Young Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gamba S, Lachat M, Alkadhi H, Simmen HP, Jensen KO. Radiographically occult perforation and dissection of the common carotid artery following stab injury to the neck. Trauma Case Rep 2018; 9:17-21. [PMID: 29644318 PMCID: PMC5883245 DOI: 10.1016/j.tcr.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2017] [Indexed: 11/17/2022] Open
Abstract
In recent years, many diagnostic algorithms have been devised to reduce the rate of negative explorations associated with indiscriminate surgical management of penetrating neck injuries. In hemodynamically stable patients, the need for surgical intervention is usually determined by integrating both clinical signs and radiological findings; if such investigations remain unremarkable, recommended treatment consists in close observation and sequential physical examinations. We report on a 29-year-old male who was admitted to a Swiss tertiary care hospital after sustaining a penetrating injury to his left neck following a knife attack. Disregarding a pre-hospital account of hemorrhage from the wound and slight dysphagia, no manifest symptoms or signs of internal organ damage were present on primary survey. Moreover, there was no evidence of vascular or aerodigestive tract injury on initial CT angiography. We nonetheless proceeded with immediate surgical exploration, exposing a significant perforation of the left common carotid artery with concomitant dissection of the said vessel. Surgical repair was successfully performed and the patient suffered no long-term sequelae. We thus recommend that a high level of suspicion be upheld in both asymptomatic and oligosymptomatic patients with PNI and that clinical practitioners remain cautious in the face of deceptively reassuring radiologic findings.
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Affiliation(s)
- Sebastian Gamba
- Division of Trauma Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Mario Lachat
- Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Kai Oliver Jensen
- Division of Trauma Surgery, University Hospital Zurich, University of Zurich, Switzerland
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Jambhekar A, Maselli A, Lindborg R, Bobka T, Fahoum B, D’Ayala M, Rucinski J. Delayed presentation of penetrating carotid injury: Two cases and a review of the literature. TRAUMA-ENGLAND 2018. [DOI: 10.1177/1460408616675644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amani Jambhekar
- Department of Surgery, New York Methodist Hospital, Brooklyn, USA
| | - Amy Maselli
- Department of Surgery, New York Methodist Hospital, Brooklyn, USA
| | - Ryan Lindborg
- Department of Surgery, New York Methodist Hospital, Brooklyn, USA
| | - Thomas Bobka
- Department of Surgery, New York Methodist Hospital, Brooklyn, USA
| | - Bashar Fahoum
- Department of Surgery, New York Methodist Hospital, Brooklyn, USA
| | - Marcus D’Ayala
- Department of Surgery, New York Methodist Hospital, Brooklyn, USA
| | - James Rucinski
- Department of Surgery, New York Methodist Hospital, Brooklyn, USA
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Forty hours with a traumatic carotid transection: A diagnostic caveat and review of the contemporary management of penetrating neck trauma. Chin J Traumatol 2018; 21:118-121. [PMID: 29563058 PMCID: PMC5911732 DOI: 10.1016/j.cjtee.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/12/2017] [Accepted: 10/09/2017] [Indexed: 02/04/2023] Open
Abstract
Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.
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Khatib B, Cuddy K, Cheng A, Patel A, Sim F, Amundson M, Gelesko S, Bui T, Dierks EJ, Bell RB. Functional Anatomic Computer Engineered Surgery Protocol for the Management of Self-Inflicted Gunshot Wounds to the Maxillofacial Skeleton. J Oral Maxillofac Surg 2018; 76:580-594. [DOI: 10.1016/j.joms.2017.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khatib B, Gelesko S, Amundson M, Cheng A, Patel A, Bui T, Dierks EJ, Bell RB. Updates in Management of Craniomaxillofacial Gunshot Wounds and Reconstruction of the Mandible. Facial Plast Surg Clin North Am 2018; 25:563-576. [PMID: 28941508 DOI: 10.1016/j.fsc.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article includes updates in the management of mandibular trauma and reconstruction as they relate to maxillomandibular fixation screws, custom hardware, virtual surgical planning, and protocols for use of computer-aided surgery and navigation when managing composite defects from gunshot injuries to the face.
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Affiliation(s)
- Baber Khatib
- Advanced Craniomaxillofacial and Trauma Surgery/Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Surgery, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Portland Hospital, 4805 NE Glisan Street, Portland, OR 97213, USA; Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA.
| | - Savannah Gelesko
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA
| | - Melissa Amundson
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - Allen Cheng
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, 1015 NW 22nd Avenue, Portland, OR 97210, USA
| | - Ashish Patel
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
| | - Tuan Bui
- Oral and Maxillofacial Pathology, Sanford Health, E - 1717 S University Drive Fargo, ND 58103, USA
| | - Eric J Dierks
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - R Bryan Bell
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA; Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
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Abstract
Traumatic esophageal injuries occur less than 10% of the time in the setting of blunt or penetrating trauma. The purpose of this literature review is to provide an update on the most recent changes involving the diagnosis and treatment of esophageal injuries. A literature search was conducted using PubMed, to identify articles written in English language with the terms "non- iatrogenic", "esophageal", "trauma", "diagnosis", "management", and "prognosis". Case reports and articles involving non-traumatic esophageal perforations were excluded. Fifty pertinent articles in English language from 1947 to 2015 were selected for review. Based on the review of all articles, we designed a diagnostic and therapeutic algorithm to facilitate the diagnosis and management of the traumatic esophageal injury.
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Choufani C, Aoun O, Mlynski A, Boddaert G, de Kerangal X, Pierret C. Endovascular treatment of brachiocephalic artery war-related injury. Acta Chir Belg 2017; 117:256-259. [PMID: 27827564 DOI: 10.1080/00015458.2016.1253236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Injuries to the innominate artery are rare, but potentially fatal. Early diagnosis and treatment may avoid life-threatening complications. Endovascular surgery often has lower morbidity and mortality rates than conventional surgery. CLINICAL CASE We reported the case of a 28-year-old Yemenite soldier who presented with a shrapnel-related chest puncture wound following a shell explosion in Djibouti causing a 5 mm pseudoaneurysm of the innominate artery without associated complications. After medical repatriation to France, the pseudoaneurysm was treated by endovascular exclusion using a covered stent. DISCUSSION Endovascular treatment of supra-aortic trunk lesions is an alternative to surgery with fewer postoperative complications, but long-term follow-up is lacking.
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Affiliation(s)
| | - Olivier Aoun
- Colmar Armed Forces Medical Center, Colmar, France
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Casal D, Pelliccia G, Pais D, Carrola-Gomes D, Angélica-Almeida M, Videira-Castro J, Goyri-O'Neill J. Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report. J Med Case Rep 2017; 11:205. [PMID: 28754171 PMCID: PMC5534056 DOI: 10.1186/s13256-017-1361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/22/2017] [Indexed: 12/03/2022] Open
Abstract
Background Open injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise. Case presentation A 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases. Conclusions This clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in the reviewed literature, which suggests that this must be a very rare occurrence. According to the dissection study performed, this is due to the existence of a triangular space between the cervicofacial and temporofacial nerve trunks in which the external carotid artery is not covered by the facial nerve or its branches.
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Affiliation(s)
- Diogo Casal
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. .,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
| | - Giovanni Pelliccia
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Diogo Pais
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Diogo Carrola-Gomes
- General Surgery Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Maria Angélica-Almeida
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - José Videira-Castro
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Goyri-O'Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
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Neskoromna-Jędrzejczak A, Bogusiak K, Przygoński A, Antoszewski B. Penetrating trauma of the face and facial skeleton - a case series of six patients. POLISH JOURNAL OF SURGERY 2017; 89:50-60. [PMID: 28522784 DOI: 10.5604/01.3001.0009.6004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Penetrating traumas of the facial skeleton are relatively rare; however, they can be dangerous and even life-threatening. The epidemiology of facial skeleton trauma is diverse and depends on the affected region, age, and the kind of foreign body that caused the injury. In Poland, the most common cause of penetrating traumas are accidents and assaults, and only rarely accidents are related to improper use of firecrackers or fireworks. The aim of this study is to present a literature review and our own experience with penetrating traumas of the face and the facial part of the cranium. Six cases with severe wounds and fractures of the facial skeleton were treated between the years 2000 and 2012 in our department. The applied treatment methods depended mainly on the general condition of the patients. In all cases, we achieved acceptable functional and aesthetic outcomes.
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Affiliation(s)
- Aneta Neskoromna-Jędrzejczak
- Medical University of Lodz Department of Craniomaxillofacial and Oncological Surgery, Head: Aneta Neskoromna-Jędrzejczak
| | - Katarzyna Bogusiak
- Medical University of Lodz Department of Craniomaxillofacial and Oncological Surgery, Head: Aneta Neskoromna-Jędrzejczak
| | - Aleksander Przygoński
- Medical University of Lodz Department of Craniomaxillofacial and Oncological Surgery, Head: Aneta Neskoromna-Jędrzejczak
| | - Bogusław Antoszewski
- Medical University of Lodz Department of Plastic, Reconstructive and Aesthetic Surgery, Head: Bogusław Antoszewski
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Bensley RP, Mohr AM, Huber TS, Sappenfield JW. Novel use of a Sengstaken-Blakemore tube during a neck exploration of a carotid injury: A case report. Injury 2016; 47:2048-50. [PMID: 27017451 DOI: 10.1016/j.injury.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 02/02/2023]
Abstract
Penetrating neck trauma can injure the major blood vessels, airway, gastrointestinal system, and neurological system. We present a case where a Sengstaken-Blakemore tube was emergently placed during surgical exploration of a stab wound to the neck to tamponade bleeding until surgical control was obtained and the vascular injuries were managed.
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Affiliation(s)
- Rodney P Bensley
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Thomas S Huber
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Joshua W Sappenfield
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
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Bodanapally UK, Sliker CW. Imaging of Blunt and Penetrating Craniocervical Arterial Injuries. Semin Roentgenol 2016; 51:152-64. [DOI: 10.1053/j.ro.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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45
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Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis. Emerg Radiol 2016; 23:421-31. [DOI: 10.1007/s10140-016-1412-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/20/2016] [Indexed: 12/23/2022]
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46
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PONCELA-BLANCO M, DÍEZ-GONZÁLEZ L, MARTÍN-PEÑA F, RODRÍGUEZ-CRESPO R, ESCAPA-GARRACHÓN JM. Traumatismo laringotraqueal. Descripción de un caso. REVISTA ORL 2016. [DOI: 10.14201/orl201672.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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47
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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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48
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Vascular Injuries to the Neck After Penetrating Trauma: Diagnostic Performance of 40- and 64-MDCT Angiography. AJR Am J Roentgenol 2015; 205:866-72. [DOI: 10.2214/ajr.14.14161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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49
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Akopian E, de Virgilio C, Kim DY. Gunshot Wound to the Left Neck. Surgery 2015. [DOI: 10.1007/978-1-4939-1726-6_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Delayed presentation of deep penetrating trauma to the subaxial cervical spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S540-3. [PMID: 25408256 DOI: 10.1007/s00586-014-3681-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To present a rare case of deep penetrating neck trauma in which a retained foreign body in the cervical spine (a broken knife blade) resulted in delayed radicular injury. We describe the surgical management using a retrojugular approach. CASE REPORT Our patient sustained a stab wound to the supraclavicular triangle from a small pocketknife. He was initially managed in a local hospital by simple primary wound closure without any radiological examinations, and was discharged home. The patient re-consulted in a delayed fashion with mild local persistent neck pain. Subsequent radiological investigations revealed a foreign body (the broken blade of a pocket knife) embedded in the left neural foramen between the C6 and C7 vertebrae penetrating the disc space. The blade was lying between the left C7 nerve root and the ipsilateral vertebral artery (VA) at the transition of V1 and V2 segments. Initial neurological evaluation was normal. Some days later, the patient developed a delayed left C7 radicular deficit. We undertook urgent exploration along the wound corridor through a retrojugular, transforaminal approach with successful removal of the blade. DISCUSSION To our knowledge, this is a unique case where a retained foreign body penetrated the soft tissues of the neck, embedding deep in the vertebral column without vascular, aerodigestive or significant primary neurological injury, while causing delayed neck pain and delayed onset radicular injury. We describe our surgical management for removal of the retained blade. The retrojugular approach gives excellent access to all of the important anatomical structures of the neck from an anterolateral approach.
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