0071643192.pdf

■ Pulse deficit
■ Horner syndrome (ptosis, myosis, anhydrosis)
■ TIA/CVA
■ Motor or sensory deficits
■ Airway compromise

DIAGNOSIS

Diagnosis is made by angiography although contrast CT scan or MRA may assist
in determining need for angiography.

TREATMENT

■ Anticoagulation
■ Surgical intervention if neurologic deficit

Penetrating Neck Trauma

In regard to penetrating trauma, the neck is anatomically divided into zones
that have both anatomic (Table 3.10) and management implications. Trauma
to any zone may injure spinal cord, vertebral arteries, and carotids.

SYMPTOMS/EXAM

■ Findings that suggest major injury (hard signs) include expanding
hematoma, severe active bleeding, vascular bruit/thrill, cerebral ischemia,
airway obstruction, and decreased/absent radial pulse.
■ Unfortunately, lack of physical findings does not rule out injury.

TREATMENT

■ Consider early intubation in patients with suspected arterial injury as expand-
ing hematomas can quickly lead to airway compromise.
■ Neck wounds with intact platysmacan be closed.
■ Violation of the platysma indicates a possibility of significant neck injury
and requires surgical consult.
■ Do not probe neck wounds beyond the level of the platysma because of
the risk of dislodging a clot.
■ Zones I and III can be difficult to evaluate surgically and therefore angio-
graphy or CT angiography is usually indicated for these injuries.
■ Zone I injuries should also undergo esophageal evaluation.
■ Zone II injuries with hard signs of injury are typically explored surgically.
■ Zone II injuries without hard signs may be evaluated with angiography
and esophageal imaging/visualization.

TRAUMA

Penetrating neck trauma

Zone I: Angiography,

esophageal, and tracheal

evaluation

Zone II: Surgery if hard signs,

otherwise angiography

Zone III: Angiography

TABLE 3.10. Zones of the Neck

ZONES LANDMARKS INVOLVEDSTRUCTURES

Zone I Clavicles to cricoid cartilage Thoracic vessels, superior mediastinum,

lungs, thoracic duct, thyroid Trachea esophagus

Zone II Cricoid cartilage to angle of mandible Jugular veins, larynx

Zone III Angle of mandible to base of skull Pharynx

To remember the zones,

remember the neck goes from

clavicles to base of skull split

into thirds at the cricoid and

angle of mandible, and that

you go up from bottom to top.