Penetrating traumatic neck injury

Last revised by Craig Hacking on 14 Mar 2024

Citation, DOI, disclosures and article data

Citation:

Gai D, Hacking C, Knipe H, et al. Penetrating traumatic neck injury. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-41052

DOI:

https://doi.org/10.53347/rID-41052

Permalink:

https://radiopaedia.org/articles/41052

rID:

41052

Article created:

13 Nov 2015, Dayu Gai ◉ ◈

Disclosures:

At the time the article was created Dayu Gai had no recorded disclosures.

View Dayu Gai's current disclosures

Last revised:

14 Mar 2024, Craig Hacking ◉ ◈

Disclosures:

At the time the article was last revised Craig Hacking had the following disclosures:

Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)

These were assessed during peer review and were determined to not be relevant to the changes that were made.

View Craig Hacking's current disclosures

Revisions:

14 times, by 8 contributors - see full revision history and disclosures

Systems:

Head & Neck, Trauma

Tags:

trauma, neck injury

Synonyms:

Traumatic neck injuries
Traumatic cervical injury
Traumatic cervical injuries
Penetrating neck injury
Penetrating neck trauma
Penetrating neck injuries

Penetrating traumatic neck injury can be a potentially devastating injury due to the high density of crucial anatomical structures within the neck.

zone 1: from the level of the clavicles and sternal notch to the cricoid cartilage
- important structures include the aortic arch, proximal common carotid arteries, vertebral arteries, subclavian vessels, innominate vessels, lung apices, esophagus, trachea, brachial plexus and thoracic duct
zone 2: from the cricoid cartilage to the angle of the mandible
- important structures include the common, internal and external carotid arteries, internal and external jugular veins, larynx, hypopharynx and proximal esophagus
zone 3: from the angle of the mandible to base of skull
- important structures include the internal carotid artery, vertebral artery, external carotid artery, jugular veins, prevertebral venous plexus and facial nerve trunk

Injuries mostly (~80%) occur in zone 2. ~10% of injuries involve two zones ⁵.

Radiographic features

Assessment of neck injuries has been aided by the use of CT angiography. Types of injury include vascular injury, esophageal perforation, laryngeal trauma and neurological injury.

Treatment and prognosis

Treatment of neck injury depends on the severity of injury and the zones of the neck which are involved. Previously, zone 2 injuries penetrating the platysma were thought to require immediate surgical exploration. One current study suggests that thorough clinical examination can prevent unnecessary surgical exploration of zone 2 neck injuries. Clinical criteria which would indicate surgical intervention/exploration include:

exsanguinating hemorrhage
expanding hematoma
shock
airway compromise
massive subcutaneous hematoma

Zone 1 and 3 injuries are evaluated more selectively, particularly due to the difficulty in their surgical accessibility ⁴.

While endovascular techniques have seen increasing use in other traumatic vascular injuries, open surgical repair is considered the gold standard for most vascular neck trauma. One study suggests that patients with stable, intimal, high zone 3 carotid injuries and vertebral artery injuries can be repaired endovascularly. Otherwise, surgical exploration is the intervention of choice.