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Hamilton JM, Chan TG, Moore CE. Penetrating Head and Neck Trauma: A Narrative Review of Evidence-Based Evaluation and Treatment Protocols. Otolaryngol Clin North Am 2023; 56:1013-1025. [PMID: 37353366 DOI: 10.1016/j.otc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Penetrating injury to the head and neck accounts for a minority of trauma but significant morbidity in the US civilian population. The 3-zone anatomical framework has historically guided evaluation and management; however, the most current evidence-based protocols favor a no-zone, systems-based approach. In stable patients, a thorough physical examination and noninvasive imaging should be prioritized, with surgical exploration of the head and neck reserved for certain circumstances. Diagnostic and management decisions should be tailored to the mechanism of injury, history, physical examination, experience of personnel, availability of equipment, and clinical judgment.
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Affiliation(s)
- James M Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Grady Memorial Hospital, Atlanta, GA, USA.
| | - Tyler G Chan
- Emory University School of Medicine, Atlanta, GA, USA
| | - Charles E Moore
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Grady Memorial Hospital, Atlanta, GA, USA
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2
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Kim HJ, Lee D, Lee K. Submandibular Injury Caused by the Close-Range Firing of a Military Blank Cartridge Shot. JOURNAL OF ACUTE CARE SURGERY 2023. [DOI: 10.17479/jacs.2023.13.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Few studies have reported injuries caused by a blank cartridge shot (BCS) into the head and neck. We experienced a case of minor injury resulting from BCS (despite the close proximity). The patient was a 20-year-old male soldier who attempted suicide by firing a BCS from a K2 rifle into his mouth. He suffered from skin and soft tissue defect in the submandibular area with burns and minimal bleeding. A computed tomography scan showed subcutaneous emphysema which was suspected to be related to the projectile gas released during the firing of the BCS, and a tiny fragment without hematoma or structure injuries. We closely observed the clinical features including the occurrence of infection and functional abnormalities. The subcutaneous emphysema faded away along with the soft tissue defect. After wound management was completed on the 13<sup>th</sup> hospital day, the patient was transferred to the Department of Psychiatry without any problems.
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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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Majors JS, Brennan J, Holt GR. Management of High-Velocity Injuries of the Head and Neck. Facial Plast Surg Clin North Am 2017; 25:493-502. [PMID: 28941503 DOI: 10.1016/j.fsc.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Trauma centers must prepare to manage high-velocity injuries resulting from a mass casualty incidents as global terrorism becomes a greater concern and an increasing risk. The most recent conflicts in Iraq and Afghanistan have significantly improved understanding of battlefield trauma and how to appropriately address these injures. This article applies combat surgery experience to civilian situations, outlines the physiology and kinetics of high-velocity injuries, and reviews applicable triage and management strategies.
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Affiliation(s)
- Jacob S Majors
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA, Fort Sam Houston, TX 78234-6200, USA.
| | - Joseph Brennan
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA, Fort Sam Houston, TX 78234-6200, USA
| | - G Richard Holt
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA, Fort Sam Houston, TX 78234-6200, USA; Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, 325 East Sonterra Boulevard, Suite 210, San Antonio, TX 78258, USA
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5
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Abstract
Penetrating injury to the neck has inspired considerable controversy with regard to its management, owing to the large number of important, susceptible structures contained in this area. Mandatory exploration of all wounds has generally given way to selective operative management. Clinical assessment has, once again, become the prime diagnostic tool. This review describes the evolution of management and the value of various diagnostic modalities. It concludes with a summary of appropriate operative techniques.
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Affiliation(s)
- Campbell MacFarlane
- Emergency Medical Services Training, Gauteng Provincial Government Department of Health and Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Ann Benn
- Chris Hani Baragwanath Hospital, Johannesburg and Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Becker M, Leuchter I, Platon A, Becker CD, Dulguerov P, Varoquaux A. Imaging of laryngeal trauma. Eur J Radiol 2013; 83:142-54. [PMID: 24238937 DOI: 10.1016/j.ejrad.2013.10.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/18/2013] [Accepted: 10/15/2013] [Indexed: 12/28/2022]
Abstract
External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.
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Affiliation(s)
- Minerva Becker
- Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Igor Leuchter
- Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Alexandra Platon
- Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Christoph D Becker
- Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Pavel Dulguerov
- Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Arthur Varoquaux
- Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
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Abstract
All penetrating neck wounds are potentially very dangerous and require emergency treatment. The choice of treatment for the stable patient remains controversial, a number of studies encouraging mandatory surgical exploration and a similar number encourage selective surgical exploration. Knowledge of the physical properties of the penetrating object or weapon can help to determine a treatment plan and predict the risk of injury- All tracheal and esophageal injuries with structural damage should be repaired primarily. A case of Gun Shot Wound Neck was air evacuated to Army Hospital R & R Delhi Cantt in a tracheostomised state. Patient was evaluated in detail, he had trachea esophageal fistula. The management of this case is discussed along with principles of management of war injuries.
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Affiliation(s)
- L K Kochhar
- Deptt. of ENT, AH ( R & R), Cantt - 10, Delhi
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Steenburg SD, Sliker CW, Shanmuganathan K, Siegel EL. Imaging Evaluation of Penetrating Neck Injuries. Radiographics 2010; 30:869-86. [DOI: 10.1148/rg.304105022] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Singh DK, Gupta A, Mittal RS, Saggar V. Penetrating injury to cervical spine from a nail gun. INDIAN JOURNAL OF NEUROTRAUMA 2009. [DOI: 10.1016/s0973-0508(09)80011-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Abstract
All penetrating neck wounds are potentially dangerous and require emergency treatment because there are important vessels, nerves and organs in the neck. We present the case of a patient who had an unusual penetrating neck injury caused by a broken windshield, noticed accidentally. Because fragments of windshield glass consist of sharp material, and the neck contains vital structures, such penetrating neck injury may cause life-threatening complications. Radiological examinations should be offered before the management of all neck wounds. The risk of retained foreign bodies and related complications can be prevented by using fluoroscopy during surgical exploration of the neck.
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Affiliation(s)
- Kayhan Ozturk
- Department of Otolaryngology, Selçuk University, Meram Faculty of Medicine, Konya, Turkey.
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12
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Verghese ST, Hannallah RS. Pediatric otolaryngologic emergencies. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2001; 19:237-56, vi. [PMID: 11469063 DOI: 10.1016/s0889-8537(05)70227-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Anesthesiologists are often consulted to help in the management of pediatric otolaryngologic emergencies. These include airway obstruction in children suffering from acute epiglottitis and croup. Surgical otolaryngologic emergencies such as foreign body aspiration, post-tonsillectomy bleeding, obstructive laryngeal papillomatosis, peritonsillar abscess, and laryngeal trauma can be life threatening. The pathophysiology, clinical course, and anesthetic management of these conditions are addressed with special emphasis on the details of airway management in each case.
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Affiliation(s)
- S T Verghese
- Departments of Anesthesiology and Pediatrics, George Washington University Medical Center, USA
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Abstract
Traumatic airway injuries fortunately are rare. While sometimes injuries are obvious and initial management straightforward, frequently the diagnosis is difficult. Prompt diagnosis of airway injuries requires a high index of clinical suspicion, complemented by judicious use of endoscopy and radiological imaging. Initial management can be complicated by associated head, neck, and thoracic injuries. Importantly, a patient's airway can be lost because of injudicious use of sedation or failure to be properly cautious during attempts at airway management and endotracheal intubation. Mortality rates and the incidence of late complications remain high and have been related to delays in diagnosis and definitive treatment.
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Affiliation(s)
- R Peralta
- Department of Surgery, Massachusetts General Hospital, Boston 02114, USA
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14
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Singh RS, Dhaliwal RS, Singh H, Batra I. Successful management of combined penetrating injury of innominate artery and trachea. THE JOURNAL OF TRAUMA 1998; 44:723-5. [PMID: 9555849 DOI: 10.1097/00005373-199804000-00029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R S Singh
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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15
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An Unusual Penetrating Neck Wound by a Golf Club: Precise Forensic Imaging. J Forensic Sci 1997. [DOI: 10.1520/jfs14194j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Affiliation(s)
- A R Lupetin
- Department of Diagnostic Radiology, Allegheny General Hospital, Allegheny University of the Health Sciences, USA
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17
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Abstract
This article discusses the problems and controversies in the assessment of penetrating injuries of the neck. The role of physical examination and color-flow Doppler imaging in the initial assessment is highlighted. Complex injuries of major vessels, the aerodigestive tract, and the parotid are discussed and therapeutic options are presented.
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Affiliation(s)
- D Demetriades
- Division of Trauma and Critical Care, Los Angeles County/University of Southern California Medical Center 90033, USA
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Danić D, Milicić D, Prgomet D, Leović D. Acute laryngeal trauma: a comparison between peace time and war injuries. J Laryngol Otol 1996; 110:435-9. [PMID: 8762311 DOI: 10.1017/s0022215100133912] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Thirty-six patients with acute laryngeal trauma are presented. Sixteen patients had peace-time and 20 had war injuries. Peace-time injuries were mostly due to car accidents, violence and suicide using a knife, whereas the war injuries were caused by shell and mine fragments. Nine patients were treated conservatively (eight peace-time and one war-time) and 27 by surgery (eight peace-time and 19 war-time). Surgical experience showed that acute laryngeal trauma must be treated within the first 24 hours after injury. Primary treatment must be a definite one. In that way complications and uncontrolled healing can be successfully avoided.
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Affiliation(s)
- D Danić
- Department of Otorhinolaryngology and Cervicofacial Surgery, Dr Josip Bencević General Hospital, Croatia
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19
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Abstract
The management of penetrating injuries of the anterior triangle of the neck is controversial and poses several problems. A policy of mandatory neck exploration of these injuries is followed in the Department of General Surgery at the State Hospital, Windhoek. A retrospective study of patients presenting to one of the four surgical firms at The State Hospital was performed to see if this policy was justified. Twenty-seven patients were reviewed of which 25 presented acutely and two presented late with severe complications. The clinical and operative findings and the mortality rate of 7 per cent were similar to previous reports. The negative exploration of 30 per cent was less than previous reports of mandatory neck exploration for penetrating trauma. This may have been because exploration was limited to injuries involving the anterior triangle of the neck in this series. All 14 patients with positive clinical findings were found to have injuries at exploration and five of 13 patients (38 per cent) with no clinical signs were found to have injuries. Given these results and in the setting of The State Hospital it was felt that the policy of mandatory exploration was justified.
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Affiliation(s)
- M S Walsh
- Department of General Surgery, State Hospital, Windhoek, Namibia
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