Head and Neck Hemorrhage: What Do I Do Now?

  • Pradeep NavsariaEmail author


The head and neck are home to numerous essential vital structures, which when injured can STOP any experienced physician or surgeon in his tracks. Securing an airway can be challenging and bleeding can be difficult to control. This ‘very little room to manoeuvre’ anatomical space when wounded can occlude the airway as a result of direct trauma to the trachea or larynx. Airway occlusion can occur due to an expanding neck haematoma or torrential oropharyngeal bleeding with the added risk of aspiration. Ventilation can be impaired from a tension pneumothorax as the apex of the lungs extends into the base of the neck. The pleural space can easily be breached from a neck wound. Exsanguination from external bleeding is possible from the base of the skull, neck and periclavicular wounds. Exsanguination from internal bleeding is possible from the oropharynx, bleeding into the pleural space, or a massive haemothorax with high-output pleural tube drainage from mediastinal vascular injuries.

It is therefore prudent to establish a definitive airway in patients with actively hemorrhaging facial and neck wounds presenting in shock and a depressed level of consciousness. Oral intubation may be difficult due to airway compression from a large haematoma, bleeding into the naso-, oro- and hypopharynx and direct injury to the laryngotracheal complex resulting in distortion/deviation/obscuration of the vocal cords. Surgical cricothyroidotomy is the alternative and should be performed early. Externally bleeding wounds can be temporarily controlled with digital compression and/or a swab on a stick.


Haemorrhage Head wounds Neck wounds Emergency surgery Surgical approach 

Suggested Reading

  1. 1.
    Mwipatayi BP, Jeffery P, Beningfield SJ, Motale P, Tunnicliffe J, Navsaria PH. Management of extra-cranial vertebral artery injuries. Eur J Vasc Endovasc Surg. 2004;27(2):157–62.CrossRefPubMedGoogle Scholar
  2. 2.
    Navsaria P, Omoshoro-Jones J, Nicol A. An analysis of 32 surgically managed penetrating carotid artery injuries. Eur J Vasc Endovasc Surg. 2002;24(4):349–55.CrossRefPubMedGoogle Scholar
  3. 3.
    Navsaria P, Thoma M, Nicol A. Foley catheter balloon tamponade for life-threatening hemorrhage in penetrating neck trauma. World J Surg. 2006 Jul;30(7):1265–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Thoma M, Navsaria PH, Edu S, Nicol AJ. Analysis of 203 patients with penetrating neck injuries. World J Surg. 2008;32(12):2716–23. doi: 10.1007/s00268-008-9766-7.CrossRefPubMedGoogle Scholar
  5. 5.
    Van Waes OJ, Cheriex KC, Navsaria PH, van Riet PA, Nicol AJ, Vermeulen J. Management of penetrating neck injuries. Br J Surg. 2012;99(Supple 1):149–54. doi: 10.1002/bjs.7733.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Surgery, TraumaGroote Schuur Hospital and University of Cape TownObservatorySouth Africa

Personalised recommendations