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Bressler S, Morris L. Pediatric Head and Neck Trauma. Otolaryngol Clin North Am 2023; 56:1169-1182. [PMID: 37460373 DOI: 10.1016/j.otc.2023.05.012] [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: 08/26/2023]
Abstract
The pediatric patient population has unique anatomic characteristics that bring challenges and increased risk to management. The purpose of this article is to guide the head and neck trauma surgeon in decision making for the treatment of pediatric head and neck trauma with an emphasis on facial fracture management.
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Affiliation(s)
- Sara Bressler
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Lisa Morris
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA.
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Pediatric Trauma. Emerg Med Clin North Am 2023; 41:205-222. [DOI: 10.1016/j.emc.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Witt CE, Sumislawski JJ, Burlew CC. Natural history and nonoperative management of penetrating cerebrovascular injury. Injury 2023; 54:131-137. [PMID: 36376123 DOI: 10.1016/j.injury.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/16/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION There is a modern precedent for nonoperative management of select penetrating cerebrovascular injuries (PCVIs); however, there is minimal data to guide management. PATIENTS AND METHODS This study assessed treatments, radiographic injury progression, and outcomes for all patients with PCVIs managed at an urban Level I trauma center from 2016 to 2021 that underwent initial nonoperative management (NOM). RESULTS Fourteen patients were included. There were 11,635 trauma admissions, 378 patients with blunt cerebrovascular injury, and 18 patients with operatively-managed PCVI during this timeframe. All patients received antithrombotic therapy, but this was delayed in some due to concomitant injuries. Three patients had stroke (21%): two before antithrombotic initiation, and one with unclear timing relative to treatment. Three patients underwent endovascular interventions. On follow-up imaging, 14% had injury resolution, 36% were stable, 21% worsened, and 29% had no follow-up vascular imaging. One patient died (7%), one had a bleeding complication (7%), and no patient required delayed operative intervention. DISCUSSION Early initiation of antithrombotic therapy, early surveillance imaging, and selective use of endovascular interventions are important for nonoperative management of PCVI.
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Affiliation(s)
- Cordelie E Witt
- Department of Trauma and Acute Care Surgery, University of Colorado Health Medical Center of the Rockies, 2500 Rocky Mountain Avenue, Loveland, CO 80538, USA.
| | - Joshua J Sumislawski
- Department of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Aurora, CO 80045, USA
| | - Clay Cothren Burlew
- Department of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Aurora, CO 80045, USA
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Vielsmeier V, Hackenberg S, Schelzig H, Knapsis A. [Update on neck trauma]. HNO 2022; 70:724-735. [PMID: 36066623 DOI: 10.1007/s00106-022-01214-5] [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] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Important organs and structures are located in the cervical region. In case of blunt and penetrating trauma, emergency situations may arise. OBJECTIVE Emergency management as well as diagnostic and therapeutic steps pertaining to neck injuries are presented. CONCLUSION Shock therapy and airway management are essential, fast management of neck injuries highly relevant.
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Affiliation(s)
- V Vielsmeier
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland.
| | - S Hackenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - H Schelzig
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - A Knapsis
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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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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DeVictor S, DeGiovanni J, Carr MM. Pediatric penetrating cervical trauma in HCUP: Associations with hospital length of stay and cost. Int J Pediatr Otorhinolaryngol 2021; 143:110661. [PMID: 33667835 DOI: 10.1016/j.ijporl.2021.110661] [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: 11/09/2020] [Revised: 01/13/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe pediatric penetrating cervical trauma (PCT) and determine factors associated with increased length of stay (LOS) and total hospital charges. STUDY DESIGN Retrospective review of Healthcare Cost and Utilization Project (HCUP) from the Kids' Inpatient Database (KID) for 2016. SETTING Public database. METHODS A retrospective analysis of the HCUP from the KID for 2016 for inpatients ≤18 years of age. Comparisons between PCT and non-PCT patients were made, including hospital LOS and total charges. RESULTS There were 1279 patients with neck trauma of which 686 (53.6%) were identified as sustaining PCT. Patients with PCT were older (13.2 vs 11.8 yr, p = .001), and were more likely to be male (65.9% vs 54.8%, p < .001) and African-American (21.9% vs 15.9, p = .01). PCT patients were less likely to have a vascular injury (6.1% vs 20.1%, p < .001) and they were more likely to undergo airway evaluation (8.3% vs 2.2%, p < .001). Within the PCT group, 11.5% had open pharyngeal/esophageal lacerations, 6.1% had open tracheal injuries, 2.0% had open thyroid injuries, and 1.6% had open laryngeal injuries. LOS and total charges were not different between children with and without PCT (mean LOS 6.5 days, mean total charges US$106,000). Linear regression analysis showed significant associations with LOS for age, tracheal open injuries, cervical or vascular injury, and undergoing airway evaluation and/or esophagoscopy. Total charges associations were similar. CONCLUSION LOS and total charges were not different in children with PCT and non-PCT, but both were increased when there were more cervical injuries and more related procedures done.
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Affiliation(s)
- Sam DeVictor
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States.
| | - Jason DeGiovanni
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Michele M Carr
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
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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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Melmer PD, Chaconas CE, McCrae AL, Sciarretta JD. Conservative Therapy for Cervical Esophageal Perforation Following Blunt Trauma. Am Surg 2020; 87:1518-1520. [PMID: 32683918 DOI: 10.1177/0003134820923327] [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)
- Patrick D Melmer
- 23765Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC, USA
| | - Christen E Chaconas
- 23765Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC, USA
| | - Allison L McCrae
- 23765Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC, USA
| | - Jason D Sciarretta
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
Penetrating injuries to the internal carotid artery are infrequent but potentially devastating and can be a significant challenge to the operating surgeon. In this article, we present a case of an 11-year-old girl who suffered a serious vascular injury when she fell on a pencil. We also discuss the most up-to-date recommendations concerning the management of zone II injuries to the neck of a paediatric patient.
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Affiliation(s)
- Monica Abdelmasih
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Kayssi
- Division of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
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Penetrating Neck Trauma: a Review. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-0154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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