Penetrating and blunt trauma to the neck: clinical presentation, assessment and emergency management
P. Verdonck , J.-C. de Schoutheete , K. G. Monsieurs , C. Van Laer , V. Vander Poorten , O. Vanderveken
Department of Emergency Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Department of Surgery, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem; Department of Otorhinolaryngology and Head/ Neck Surgery, University Hospital Leuven, KU Leuven, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
Airway obstruction; emergency medicine; multiple trauma; interventional radiology; vascular systemic injuries
69 - 85
Penetrating and blunt trauma to the neck: clinical presentation, assessment and emergency management. In Belgium, and even in Western Europe, penetrating and blunt injury to the neck is relatively uncommon in both the civilian and military populations. Pre-hospital and emergency assessment and management will therefore always prove challenging, as individual exposure to this specific type of injury remains low. Historically, the neck has been divided into three anatomical zones with specific landmarks to guide the diagnostic and therapeutic approach to penetrating neck injuries. Most penetrating injuries need to be explored surgically, although with the advent of multi-detector computed tomographic angiography (MDCTA), which yields high diagnostic sensitivity, this inflexible approach has recently changed to a more targeted management, based on clinical, radiographic and, if deemed necessary, endoscopic findings. However, some authors have addressed their concern about this novel, ‘no-zone’approach, since the risk of missing less apparent aerodigestive tract injuries may increase. It is recommended, therefore, that all patients with penetrating neck injuries be closely observed, irrespective of the initial findings. The incidence of blunt neck injury is much lower, and this makes risk assessment and management even more difficult in comparison with penetrating injuries. Again, MDCTA is most often the first diagnostic tool if a blunt neck injury is suspected, due to its good sensitivity for blunt cerebrovascular injuries (BCVI) as well as for aerodigestive tract injuries. Specific patterns of injury and unexpected neurological and neuro-radiological findings in trauma patients should always warrant further investigation. Despite ongoing debate, systemic anticoagulation is recommended for most BCVI, some- times combined with endovascular treatment.Aerodigestive tract injuries may present dramatically, but are often more subtle, making the diagnosis more difficult than other types of neck injuries. Treatment may be conservative if damage is minimal, but surgery is warranted in all other cases.
Suppl. 26.2, 2016

Penetrating and blunt trauma to the neck: clinical presentation, assessment and emergency management