Penetrating trauma to the neck can cause injury to any of the closely packed structures of the anterior neck. A systematic approach to the evaluation and management of penetrating neck wounds will decrease the number of missed injuries. The high morbidity and mortality rates from vascular and aerodigestive tract injuries initially led to the practice of mandatory neck exploration for all penetrating neck wounds. Subsequently, selective angiography and esophagography for selected cases were used to determine if non-operative management was feasible and to decrease the number of negative neck explorations. Selective observation in patients undergoing invasive testing appears to accomplish its stated purpose, i.e., reduce the number of negative explorations, however, significant injuries may be missed and it is no more cost-effective than mandatory exploration for all patients. Regardless of location or type of injury, immediate exploration is indicated if there are any clinical signs of significant injury. These signs may include significant external hemorrhage, expanding hematoma, subcutaneous emphysema, hemoptysis, stridor, dysphonia, dysphagia, odynophagia, or neurologic deficit.
KeywordsSubcutaneous Emphysema Invasive Testing Significant Injury Comatose Patient Neck Exploration
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