4/11/2024 0 Comments Hard soft signs neck traumaGunshots (and long knives) may enter multiple zones. What zone is the injury in? And don’t just look at the obvious entry point.The patient should be taken directly to OR after control of the airway, if appropriate. Are there hard signs of injury present? These tell us that a structure that absolutely needs to be fixed has been injured.But we’ve become more selective now with the advent of improved resolution of our CT scans.Ĭurrently, we usually follow a two-step approach to penetrating neck trauma: Yes, there were quite a few negative explorations. In the old days, an injury to this area went straight to the OR regardless of whether there were signs or symptoms of injury. Exposure is simple and the operation is fun. Zone II is everything in-between the mandibular angle and cricoid cartilage. And endovascular / angiographic techniques are now available that may obviate the need for surgery. For this reason, imaging is very desirable and often demonstrates that no significant injury is present. This is challenging and not that desirable, and few surgeons are familiar with the technique. Surgical approach may require dislocation of or fracturing the mandible to get at this area. Injuries to this area may involve the distal carotid and vertebral arteries near the base of the skull, as well as the distal jugular vein. Similarly, the area above the angle of the mandible is Zone III, and is also difficult to expose. Unstable patients must go straight to the OR and the trauma surgeon will determine the surgical approach on the fly. Obviously, this can only be considered in the stable patient. For this reason, diagnostic testing is recommended to assist in determining if an operation is actually needed and what the best surgical exposure would be. The area below the cricoid cartilage is considered Zone I and contains many large vascular and aerodigestive structures that are relatively difficult to approach surgically. The zones are numbered in reverse, from bottom to top, and in Roman numerals. In my next post, I’ll discuss an alternative way to approach it.įirst, lets look at the time-honored zones of the neck. Could it be time? Today, I’ll review some of the basics of classic diagnosis and treatment. The management of penetrating injuries to the neck has changed very little over the years.
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