![]() ![]() Thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins).Zone I contains the following structures: It extends from the sternal notch and clavicles to the cricoid cartilage. Zone I is the most caudal and includes the base of the neck and thoracic inlet. Anterior neck: ( figure 2 and figure 3 and figure 4)Ĭlinicians generally describe penetrating neck trauma according to the zone of injury, with the neck being divided into three zones ( figure 1).The following illustrations convey that complexity and depict the structures of the neck in detail from anterior and lateral perspectives: ĪNATOMY - Neck anatomy is complex with aerodigestive and neurovascular structures confined to a small area. Unstable cervical spinal column injuries are rare. Mortality from pharyngoesophageal injuries is as high as 22 percent. Mortality from penetrating laryngotracheal trauma is reported to be 20 percent. Less common injuries included the subclavian artery (2.2 percent), vertebral artery (1.3 percent), brachial plexus (1.9 percent), cranial nerves IX and X (0.9 percent), and the thoracic duct (<0.1 percent). ![]() Spinal cord injury occurred in 3 percent. Vascular injuries were also common: 9 percent of patients sustained internal jugular vein injury, and 6.7 percent sustained carotid artery injury. Ten percent of such patients had laryngeal or tracheal injury, and 9.6 percent had pharyngeal or esophageal wounds. According to this review, the aerodigestive tract was injured most frequently. (See 'Anatomy' below.)Ī review of studies published from 1963 through 1990, which included over 2495 patients with PNI, reported that zone II injuries (between cricoid cartilage and angle of the mandible) are most common, followed by zone I and then zone III (above the angle of the mandible to the base of the skull). Concomitant injury beyond the neck is common. ![]() The incidence of carotid artery injury from a PNI ranges from 6 to 17 percent. Exsanguination is the most common cause of immediate death, and the carotid artery is the structure most often involved. Mortality rates for PNIs appear to be highest with zone I injuries (below the cricoid cartilage) due in part to the proximity of mediastinal structures, the severity of the vascular injuries sustained, and surgical challenges. PNI has been categorized by anatomic zones ( figure 1), which are described below. Mortality from PNI during the past decade is reported to be approximately 5 percent in both civilian and war populations. High velocity injuries carry a greater likelihood of serious injury and death. Wounds caused by low-velocity guns or impaling objects tend to cause fewer aerodigestive and vascular injuries. Penetrating thoracic trauma: (see "Initial evaluation and management of penetrating thoracic trauma in adults" and "Approach to the initially stable child with blunt or penetrating injury")ĮPIDEMIOLOGY - Penetrating neck injuries (PNIs) comprise 5 to 10 percent of traumatic injuries in adults and are caused primarily by bullets, knives, and other impaling objects (eg, shrapnel, glass).General pediatric trauma: (see "Trauma management: Approach to the unstable child" and "Approach to the initially stable child with blunt or penetrating injury" and "Trauma management: Overview of unique pediatric considerations").General adult trauma: (see "Initial management of trauma in adults" and "Approach to shock in the adult trauma patient").General evaluation of the trauma patient and the management of other injuries are discussed separately. The initial evaluation and management of PNIs is reviewed here. PNI can cause life-threatening injuries to the aerodigestive and neurovascular systems. INTRODUCTION - Penetrating neck injuries (PNIs) refer to neck injuries resulting from gunshot wounds, stab wounds, or penetrating debris (eg, glass or shrapnel) that penetrate the platysma. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |