Penetrating zone II neck injury by broken windshield

Shrapnel in carotid sheath: A rare penetrating neck injury

Injuries deeper than the platysma are considered as penetrating neck injuries, constituting approximately 5% - 10% of all trauma. Many vital organs are at risk from a penetrating neck injury. These injuries in zone 1 have the highest mortality, because the injuries are close to the vital organs and difficult to access surgically. A 41-year-old male, a car mechanic by profession, presented to the emergency department with a penetrating neck injury on the right side. CT scan demonstrated a metallic foreign body in zone 1 between the right internal jugular vein and the common carotid artery. The patient was asymptomatic, and the foreign body was removed surgically. This case shows a rare presentation of a penetrating neck injury with a foreign body located in zone 1, where no vital internal structure was injured. As of now, no previous case report has been identified on such presentation. Thus, it will provide a valuable addition to the pre-existing literature.

Crossbow Bolt Penetrating the Neck Removed with the Assistance of an Endovascular Approach: A Case Report and Literature Review

Penetrating neck injury by a crossbow bolt is extremely rare and can be life-threatening. When removing a crossbow bolt from the neck, it is necessary to protect against fatal bleeding from the carotid vessels. We report removing a crossbow bolt penetrating the neck, with an endovascular approach. A 49-year-old woman was shot in the neck by a crossbow and was transferred to our hospital. On presentation, the crossbow bolt totally penetrated the neck from right to left. Her level of consciousness was clear, with no significant neurological deficits except for right peripheral facial palsy. Neck contrast-enhanced computed tomography revealed the crossbow bolt in contact with bilateral external and internal carotid arteries and that the bolt caused dissection of the left main trunk of the external carotid artery. Under general anesthesia, the crossbow bolt was removed under fluoroscopy with the assistance of an endovascular approach. First, we performed coil embolization for the dissected external carotid artery. Second, we prepared for fatal bleeding from the carotid arteries during crossbow bolt removal under protection using guiding catheters placed in bilateral common carotid arteries. The bolt was removed successfully without significant bleeding, and no complications occurred during the procedure. We report the successful removal of a crossbow bolt penetrating the neck. When removing a crossbow bolt penetrating the neck, endovascular assistance may be feasible to protect against fatal bleeding from the carotid arteries.

Do lodged foreign bodies in the neck need to be removed? No defined criteria in 2020. Fluoroscopy role and review of literature: A case report

Penetrating neck wounds can be fatal and require prompt attention. The trauma literature is flooded with management protocols for penetrating wounds to the neck; however, in the absence of hard signs the definitive management of lodged foreign bodies beyond the platysma is less clear. This report describes a work-related injury of a Caucasian 33-year-old male who arrived in the Emergency Department (ER) with a 1 cm metallic foreign body (FB) lodged in zone II of the neck, 7 mm antero-lateral to the right internal carotid artery. The technical aspects of its retrieval are discussed as well as a literature review of the current management of embedded FBs in the neck. The patient was taken to the operating room and the FB was removed via a 3 cm incision. Fluoroscopy was used for exact localization of and to allow a precise skin incision overlying the FB. The FB was retrieved uneventfully; a fiberoptic esophagoscopy and bronchoscopy showed normal findings. The patient was discharged home the next day. At 15 months follow-up he is doing well without sequela. The use of fluoroscopy is strongly encouraged for FB removal in asymptomatic patients. The management of lodged foreign bodies in the neck should be part of future guidelines.

Glass injuries seen in the emergency department of a South African district hospital

BACKGROUND

The emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail.

AIM

The objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries.

SETTING

The emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa.

METHODS

This was a cross-sectional study with a sample size of 104 patients. Descriptive statistics were used to assess the characteristics of the glass injuries.

RESULTS

Five different types of glass were reported to have caused the injuries, namely car glass (7.69%), glass ampoules (3.85%), glass bottles (82.69%), glass windows (3.85%) and street glass shards (1.92%). Glass bottle injuries were mainly caused by assaults (90.47%) and most victims were mostly young males (80.23%). The assaults occurred at alcohol-licensed premises in 65.11% of cases. These injuries occurred mostly over weekends (83.72%), between 18:00 and 04:00. The face (34.23%) and the scalp (26.84%) were the sites that were injured most often.

CONCLUSION

Assault is the most common cause of glass injuries, usually involving young men at alcohol-licensed premises. Glass injuries generally resulted in minor lacerations, with few complications (2.68%).

Glass particle injury to the maxillofacial region

A retrospective study was carried out wherein 10 patients with glass particle injury reporting to the Department of Oral and Maxillofacial Surgery between January 2011 and March 2012 were included. Preoperative photographs and radiographs were done, and detailed surgical planning followed. Ninety percent of the patients were males with involvement of the right side of the face in 70% of the cases. The most common presenting symptom was patient sensation, which was the reason for availing delayed treatment in 70% of cases, followed by delayed or fibrotic healing (20%) and pain (10%). The diagnosis and planning were done based on computed tomographic scan (50% cases), plain radiographs (30%), needle as tactile aid (10%), and palpation (10%). Eighty percent of cases were diagnosed/presented late. The timely diagnosis of glass particle injuries requires a high degree of suspicion for the same. A systematic diagnosis and treatment planning for such injuries can minimize the morbidity and prevent such injuries from being overlooked at time of primary injury.

A rare presentation of pellet injury in the neck

Penetrating neck injuries are dangerous and deserve emergency treatment by virtue of the vital structures present underneath. There is a potential risk of unrecognized vascular injury and retained foreign bodies with their associated complications in these wounds. Therefore, an early diagnostic workup to localize the site of injury and an immediate neck exploration are important.

A rare case of a glass fragment impacted in the parapharyngeal space associated with neurovascular compromise

It is rare for foreign bodies to be found in the parapharyngeal space due to the protection of the mandibular ramus and zygomatic bone. The authors describe a rare case of a patient with an unusual penetrating neck injury caused by broken windshield glass in a traffic accident, which lodged in the parapharyngeal space and punctured the internal jugular vein and cranial nerves. 3 weeks later, a delayed exploration was performed on the patient after detailed evaluation of the relationship between the foreign body and the great vessels. The authors removed the glass fragment easily with no active bleeding because it had been surrounded by a fibrous envelope. This experience indicates that increasing the duration of foreign body retention in the parapharyngeal space may be helpful, allowing fibrosis to surround the foreign body, reducing the risk of active bleeding when it is removed.

Penetrating neck injuries

The incidence of penetrating and lacerated neck injuries has been rising in recent decades largely because of urban violence. Injury to the neck frequently results in multiple regional injuries and in addition poses serious threat to vital structures in the neck.From 1999 to 2005, forty-two cases of penetrating neck injuries which were treated in our hospital were included in this study. Thirty one (73.8%) injuries were due to homicide, six cases (14.2%) were due to suicide attempt and five (11.9%) were accidental injuries. Surgical management included tracheostomy neck exploration and wound repair. All the patients were followed up for a minimum period of six months. Six patients (14.2%) had unilateral vocal cord paralysis. Two patients (4.7%) developed tracheal stenosis.A proper evaluation, rapid air way intervention and proper surgical repair are essential for a successful outcome.