Neck Trauma

Aetiology

  • Higher incidence in males, especially adolescents/YAs

Penetrating neck trauma

  • Knife/BSW/MVA
  • Industrial accidents
  • Household accidents

Blunt neck trauma

  • MVA
  • Sporting injuries

Pathophysiology

Classification

notion image
Zone I
  • Trachea
  • Oesophagus
  • Thoracic duct
  • Thyroid
  • Vessels - brachiocephalic, subclavian, common carotid, thyrocervical trunk
  • Spinal cord
Zone II
  • Larynx
  • Hypopharynx
  • CN X, XI, XII
  • Vessels - carotids, internal jugular
  • Spinal cord
Zone III
  • Pharynx
  • Cranial nerves
  • Vessels - carotids, IJV, vertebral
  • Spinal cord

Clinical presentation

Important questions to ask

  • Mechanism of injury
  • Pain
  • Aerodigestive tract - dyspnoea, hoarseness, dysphona, dysphagia, haemoptysis
  • CNS problems - paraethesias, weakness

Signs

  • ABCDE
  • Inspect through platysma
  • Zone of neck
  • Bleeding/haematoma
  • Aerodigestive injuries
  • Neurological - power, sensation upper arm

Investigations and management

  • FBC, G+S/XM
  • CXR - haemopneumothorax, emphysema
  • CT angiogram
  • Urgent exploration - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
  • Laryngoscopy, bronchoscopy, pharyngoscopy, and oesophagoscopy
  • Angiography - embolise, occluse