Chapter 17 Soft tissue neck injuries

Introduction History of soft tissue neck injury Neck anatomy Mechanisms of injury Epidemiology Initial management Investigations Operative management Management of specific structural injuries Prognosis following soft tissue injury of the neck References

Introduction This chapter aims to discuss the management of soft tissue neck injuries. It is specifically directed away We mainly refer to penetrating neck injuries, however the assessment and mana Soft tissue injuries in the neck are difficult to assess and manage. This compact, A thorough review of current literature has been made to give the best available

General Points about soft tissue injuries of the neck Difficult to assess Difficult to manage

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Chapter 17 Soft tissue neck injuries

Surgical exposure is a challenge Controversy regarding mandatory exploration or selective conservatism

History -

First documented treatment of vascular injury in the neck Ambrose Pare 1510-1590 1803, Fleming ligated lacerated common carotid artery 2nd world war, 851 cases of neck injury were reported with a 7% mortality, in Vietnam this rose to 1 1944, Bailey proposed early exploration of all cervical haematomas on the basis of wartime experie 1956, Fogelman and Stewart (Fogelmann & Stewart 1956) reported a series of 100 patients showi Subsequently the rate of negative neck explorations increased and the operative mortality fell lead

Neck anatomy The anatomy of the neck is unique as it contains many vital structures representing the most important b The anatomical structures in the neck structures are invested by two fascial layers:

1. The superficial fascia lies just beneath the skin and encompasses the body of platysma (a thin sup 2. The deep cervical fascia can be subdivided into investing, pre-tracheal and pre-vertebral layers. -

The investing fascia encompasses the sternocleidomastoid, omohyoid and trapezius muscles as it The pre-tracheal fascia attaches to the thyroid and cricoid cartilages and blends with the pericardiu The pre-vertebral fascia encompasses the pre-vertebral muscles and blends with the axillary sheat The carotid sheath is formed by all 3 components of the deep fascia.

Anatomy
Neck contains structures representing different systems: Cardiovascular Respiratory Digestive Endocrine Central nervous system

Such tight fascial compartmentalisation of the neck structures limits external blee

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Chapter 17 Soft tissue neck injuries

Penetrating neck injury is most 1: Cross sectional view of cervicalzone of injury (Fig. 2), rather than triang Figure commonly referred to in terms of fascial planes (from Gray SW, Skanda

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Chapter 17 Soft tissue neck injuries

Classification Mechanisms risk zones Spinal Salivary inferiorly injury of Distal Angle Trachea injury Arteries III Vagus cartilage the and can Larynx,nerve, of inferiorly up the Carotid2: Anatomic Carotid, Vertebral Cricoidcord of of Oesophagus be Internal II Oesophagus, & Pharynx Base Vein Duct Major ofand Mandible to Laryngeal accomplished the inferior Proximal theand neck injury ThoracicXIIauthors usemandible border of anatomical edition. Appleton & Claviclesglands, Cranial (Note Mediastinum, the in Moore & I Structures at TracheaArteries - Some (from Apicescord BoundariesVertebralthenervesand-nerve Feliciano,of the lungs Zone Carotid Recurrent Jugular IXskulland Subclavian cartilage AnatomicCommon toSuperiortoofneckangle &the Cricoid ArteriesMattox: the mandible as the upper bound Figurevessels of Vertebralinferiortheaspect ofofSpinal different ways. The Trauma 3rd site of injury and the zones &

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Chapter 17 Soft tissue neck injuries

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Chapter 17 Soft tissue neck injuries

ThereABC other clinical examination findings for allowsinjury evaluation of thispermission) has been et al. - Direct pressure to Figure 3:on this chart zones of methodical examination al. 1997;Velmahos propo Operate or investigate feelbleeding examination the neck, (Klyachkin et of injury Thorough transferA basedtoAlgorithm in neck aand recording (with typeof the structures involved Immediateschemesto hospital Treatment are approach Emergency the We control that chart aid

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Chapter 17 Soft tissue neck injuries

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Chapter 17 Soft tissue neck injuries

Colour Gold flow Injury patients technology (helical Angiography Fast lateral Non-invasive Stable inexpensive, spine body, CT) CT Standard available haemodynamically stable oesophageal morbidity foreign Quick,to newerwith 4 All patients / Disadvantages Plainwithall Doppler foreignX-Ray laryngotracheal time Advantagescervical non-invasive assessment of bony consuming, Velmahos1.73%, Surgical IndicationsZones I-III in assessment but invasive, orD, Asensio JA,injury suspected bodies Clinics o Investigationsvascular Figure 4: From Demetriadespts*structures and possible G et al;mortality 0.03% (e

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