Penetrating Neck Trauma

The neck has many vital structures packed into a small amount of space vulnerable to penetrating trauma. Injuries to the airway and arteries that course this region are the primary cause of immediate morbidity and mortality. But just as morbid are unidentified/unassuming-isolated injuries to the esophagus. Penetrating injury may be caused by projectile or blade with each assuming different subtleties in management. Penetrating injury caused by projectiles is associated with a higher incidence of significant injury, yet a stab wound tract commonly is more difficult to delineate, often underestimating the potential for and significance of injury. Although, the majority of isolated Zone II injuries (~;50%) are caused by knife wounds, surgical management is more frequently required in those sustaining gunshot wounds (GSW); 60 and 80% respectively. Absolute indications, regardless of mechanism, such as hemorrhage, expanding hematoma, neurologic deficit, airway compromise, or impaled object necessitate emergent surgical management. Other symptoms such as subcutaneous emphysema, hemoptysis, stridor, odynophagia, or dysphagia also often necessitate urgent surgical exploration.

The neck is divided into three zones by horizontal planes. Two different classifications are described based on different borders. Monson et al. in 1969 described the first classification. Here, Zone I is described as below the medial head of the clavicles, Zone II between the medial head of the clavicles and the angle of the mandible, and Zone III above the angle of the mandible. This classification was proposed to better identify areas of the neck that warrant further diagnostic studies (namely angiography) prior to operative management in preparation of appropriate and possibly complicated exposure. Later, a second definition was introduced changing the borders of Zone I and II to the cricoid cartilage. It is important when reviewing this literature to make this distinction for comparison of outcomes. Zone I injuries often necessitate median sternotomy or clavicle resection while Zone III injuries may require mandibular disarticulation; hence the need for further diagnostic modalities in preparation for operative management.